Abstract
(1) Background: Wait times to chemotherapy are associated with morbidity and mortality in breast cancer patients; however, it is unclear how primary care physician (PCP) continuity impacts these wait times, or whether this association is different in immigrants, who experience cancer care inequities. We assessed the association between PCP continuity and the contact-to-chemotherapy interval (wait time from when a patient first presents to healthcare to the first day of receiving breast cancer chemotherapy), with a specific look at the immigrant population. (2) Methods: Population-based, retrospective cohort study of women who were diagnosed with stage I–III breast cancer in Ontario who received surgery and adjuvant chemotherapy. We used quantile regression at the median and 90th percentile to quantify the effect of PCP continuity on the contact-to-chemotherapy interval, performing a separate analysis on the immigrant population. (3) Results: Among 12,781 breast cancer patients, including 1706 immigrants, the median contact-to-chemotherapy interval (126 days) was 3.21 days shorter (95% confidence interval (CI) 0.47–5.96) in symptom-detected patients with low PCP continuity, 10.68 days shorter (95% CI 5.36–16.00) in symptom-detected patients with no baseline PCP visits and 17.43 days longer (95% CI 0.90–34.76) in screen-detected immigrants with low PCP continuity compared to the same groups with high PCP continuity. (4) Conclusions: Higher PCP continuity was not associated with a change in the contact-to-chemotherapy interval for most of our study population, but was associated with a marginally longer interval in our symptom-detected population and a shorter contact-to-chemotherapy interval in screen-detected immigrants. This highlights the importance of PCP continuity among immigrants with positive screening results. Additionally, having no PCP visits at baseline was associated with a shorter contact-to-chemotherapy interval in symptom-detected patients.
Highlights
Breast cancer is the second most common cause of cancer death in Canadian women [1].Treating breast cancer often involves surgery and sometimes adjuvant chemotherapy to reduce the risk of recurrence
We looked at two sub-intervals of the contact-tochemotherapy interval: the primary care interval (from the index contact date to the date of first breast cancer specialist consultation, as defined by the Aarhus Statement used by the International Cancer Benchmarking Partnership (ICBP) [41,42]), and the surgery-to-chemotherapy interval
There were 12,781 women in our cohort (Table 1), including 1706 Canadian immigrants. Those with no baseline primary care physician (PCP) visits (n = 800, 6.3%) were more likely to live in remote rural locations, be in the lowest two income quintiles and be diagnosed with stage II/III disease
Summary
Breast cancer is the second most common cause of cancer death in Canadian women [1]. Treating breast cancer often involves surgery and sometimes adjuvant chemotherapy to reduce the risk of recurrence. From 2010 to 2012, 88% of Canadian women with breast cancer received surgery [2], and from 2007 to 2012, 35–41% of Canadian women with stages I–III breast cancer received adjuvant chemotherapy [3]. Longer wait times were associated with minority race, older age, comorbidity, rural residence, lower education, stage I breast cancer, mastectomy, gene expression profile testing and being covered through public insurance [12,13,14,15,16,17,18,19,20]. Within Canada and Ontario, shorter wait times were associated with assessment through dedicated breast assessment centres and treatment in South Central Ontario [21,22,23]
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