Abstract
Abstract
Introduction
Reducing variations in cancer treatment and survival is a key aim of the NSW Cancer Plan. Variations in breast cancer treatment and survival in NSW by remoteness and socioeconomic status of residence were investigated to determine benchmarks. Reducing variations in cancer treatment and survival is a key aim of the NSW Cancer Plan. Variations in breast cancer treatment and survival in NSW by remoteness and socioeconomic status of residence were investigated to determine benchmarks.
Methods
A retrospective cohort study used linked data for invasive breast cancers, diagnosed in May 2002 to December 2015 from the NSW Cancer Registry, with corresponding inpatient, and medical and pharmaceutical insurance data. Associations between treatment modalities, area socioeconomic status and residential remoteness were explored using logistic regression. Predictors of breast cancer survival were investigated using Kaplan–Meier product-limit estimates and multivariate competing risk regression.
Results
Results indicated a high 5-year disease-specific survival in NSW of 90%. Crude survival was equivalent by residential remoteness and marginally lower in lower socioeconomic areas. Competing risk regression showed equivalent outcomes by area socioeconomic status, except for the least disadvantaged quintile, which showed a higher survival. Higher sub-hazard ratios for death occurred for women with breast cancer aged 70 + years, and more advanced stage. Adjusted analyses indicated more advanced stage in lower socioeconomic areas, with less breast reconstruction and radiotherapy, and marginally less hormone therapy for women from these areas. Conversely, among these women who had breast conserving surgery, there was higher use of chemotherapy. Remoteness of residence was associated in adjusted analyses with less radiotherapy and less immediate breast reconstruction. In these short term data, remoteness of residence was not associated with lower survival.
Conclusion
This study provides benchmarks for monitoring future variations in treatment and survival.
Funder
National Breast Cancer Foundation
Publisher
Springer Science and Business Media LLC
Reference48 articles.
1. Australian Institute of Health and Welfare (2020) Cancer data in Australia 2020. Australian Institute of Health and Welfare. https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/contents/summary. Accessed 26 November 2020
2. AIHW (2019) Cancer in Australia 2019. vol Cat. no. CAN 123. AIHW, Canberra
3. AIHW (2016) Australia’s Health 2016. AIHW, Canberra
4. Cancer Australia (2018) National Cancer Control Indicators: Distribution by stage. Cancer Australia. https://ncci.canceraustralia.gov.au/diagnosis/distribution-cancer-stage/distribution-cancer-stage. Accessed 26 November 2020
5. Baade PD, Turrell G, Aitken JF (2011) Geographic remoteness, area-level socio-economic disadvantage and advanced breast cancer: a cross-sectional, multilevel study. J Epidemiol Comm Health 65(11):1037–1043. https://doi.org/10.1136/jech.2010.114777
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