Women with early stage breast cancer receive different care depending on where they live in Canada
Women with breast cancer are receiving different care depending on where they live in Canada, according to researchers at ICES, a non-profit research institute that uses population-based health information to produce knowledge on a broad range of health care issues. The researchers examined lumpectomy, mastectomy, and chemotherapy rates in four provinces. They also looked at how often the women who received chemotherapy visited the emergency department or were admitted to hospital during treatment.
The study, published today in Current Oncology, looked at women newly diagnosed with stage I to III breast cancer who underwent surgery in British Columbia, Manitoba, Ontario and Nova Scotia. The women were followed for six months after the initial treatment and subsequent care (adjuvant or neoadjuvant chemotherapy, or no additional treatment).
“Our findings show that there are significant differences in the local delivery of treatment and acute care use, and understanding those differences will help to identify opportunities for learning and improvement,” says Dr. Monika Krzyzanowska, lead author of the study, senior adjunct scientist at ICES and medical oncologist at Princess Margaret Cancer Centre.
Breast cancer is the most common form of cancer in women in Canada, accounting for about 25 per cent of new cancer cases every year and approximately 13 per cent of cancer-related deaths in women.
The researchers looked at data on 50,224 women diagnosed with breast cancer: 11,701 in British Columbia; 3,736 in Manitoba; 31,575 in Ontario and 3,212 in Nova Scotia and found:
- A similar proportion of patients underwent lumpectomy across provinces (67.2-71.2 per cent)
- Mastectomy was more common in Nova Scotia compared to other provinces (51.7 per cent vs 33.3-36.9 per cent)
- Radiotherapy was used more commonly in British Columbia and Ontario than in Manitoba or Nova Scotia (70.3 per cent and 64.0 per cent vs. 56.3 per cent and 55.2 per cent)
- The proportion of patients that received adjuvant or neoadjuvant chemotherapy varied by province (35.3-40.7 per cent and 2.5-5.7 per cent, respectively)
- Patients treated in Ontario were most likely to have chemotherapy (46.4 per cent), while patients treated in Nova Scotia were least likely to receive chemotherapy (38.0 per cent)
- The proportion of women who received chemotherapy and had at least one emergency room visit was highest in Ontario (36.1 per cent) and lowest in British Columbia (16 per cent)
- In contrast, the proportion of women who were hospitalized was highest in British Columbia (26.7 per cent) and lowest in Ontario (6.4 per cent)
- The proportion of women who had an emergency room visit that led to a hospitalization was similar across provinces (13.9 per cent-16.8 per cent).
“Our findings along with the observed association between geographical location and receipt of treatment suggests that there may be issues with access or availability of some treatment modalities in provinces particularly with less population density or higher travel distances to nearest cancer facilities, such as Manitoba or Nova Scotia,” adds Dr. Krzyzanowska.
The study “Cross-Canada differences in early-stage breast cancer treatment and acute-care utilization,” was published in Current Oncology.
Author block: Powis M, Groome P, Biswanger N, Kendell C, Decker KM, Grunfeld E, McBride ML, Urquhart R, Winget M, Porter GA, Krzyzanowska MK, for the Canadian Team to Improve Community-Based Cancer Care Along the Continuum (CanIMPACT).
ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting health care needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name. For the latest ICES news, follow us on Twitter: @ICESOntario
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