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Ancillary Treatment Referrals and Visits After Breast Cancer Surgery in a Sociodemographically Diverse Population. | LitMetric

AI Article Synopsis

  • The study evaluated the referral rates and usage of ancillary therapeutic services for breast cancer patients at a major urban cancer center from 2010 to 2017, focusing on how demographic factors affected these rates.
  • Results showed that while many patients were referred to ancillary services, usage was significantly higher among those with private insurance, higher education levels, and Hispanic ethnicity, reflecting disparities in access to care.
  • Minority patients and those from disadvantaged backgrounds had notable referral rates, but lower actual engagement with these services, indicating a gap that needs to be addressed in patient support post-surgery.

Article Abstract

Background: Ancillary therapies with rehabilitative, palliative, and survivorship specialists mitigate adverse effects of breast cancer surgery. Existing data suggest that patients from disadvantaged backgrounds may be less likely to receive these services. This study aimed to assess variations in ancillary provider referrals and patient visits at a high-volume urban cancer center.

Methods: Electronic health records of breast cancer surgical patients at the Yale-New Haven Health System between 2010 and 2017 were reviewed. The primary end points were postoperative referral to ancillary service providers and patient use of ancillary services (defined as attending ≥ 1 consultation). Associations between end points and demographic/disease variables were identified in uni- and multivariable logistic regression analyses.

Results: The study identified 5496 patients: 2288 patients (41.6%) referred to ancillary services and 1572 patients (28.6%) who attended one or more consultations. Referrals were highest among the patients with Hispanic (57.5%) or black (54.9%) ancestry, no health insurance (57.6%), lowest percentage of high school degrees for the zip code area (50.5%), and poorest median income bracket (50.7%). Associations remained significant in the multivariable analysis (p < 0.05). Minority race remained associated with referrals in analyses of each ancillary service individually. Visits to ancillary specialists were greatest among the patients with private insurance (70.7%), highest percentage of high school degrees (72.8%), highest median household income (72.2%), and Hispanic ethnicity (73.5%). Highest median household income (odds ratio [OR] 1.45; p = 0.02) and Hispanic ethnicity (OR, 1.50; p = 0.05) remained associated in the multivariable analysis.

Conclusions: In a well-resourced health system serving a demographically diverse population, traditional markers of poor health care access were associated with referral for ancillary treatment after breast cancer surgery but not with utilization of ancillary treatment. Health care access remains a critical barrier to adjunctive therapies that target postoperative morbidity and elevate quality of life.

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Source
http://dx.doi.org/10.1245/s10434-023-13431-5DOI Listing

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