Patterns and predictors of breast cancer chemotherapy use in Kaiser Permanente Northern California, 2004-2007

Allison W. Kurian, Daphne Y. Lichtensztajn, Theresa H Keegan, Rita W. Leung, Sarah J. Shema, Dawn L. Hershman, Lawrence H. Kushi, Laurel A. Habel, Tatjana Kolevska, Bette J. Caan, Scarlett L. Gomez

Research output: Contribution to journalArticle

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Abstract

Chemotherapy regimens for early stage breast cancer have been tested by randomized clinical trials, and specified by evidence-based practice guidelines. However, little is known about the translation of trial results and guidelines to clinical practice. We extracted individual-level data on chemotherapy administration from the electronic medical records of Kaiser Permanente Northern California (KPNC), a pre-paid integrated healthcare system serving 29 % of the local population. We linked data to the California Cancer Registry, incorporating socio-demographic and tumor factors, and performed multivariable logistic regression analyses on the receipt of specific chemotherapy regimens. We identified 6,004 women diagnosed with Stage I-III breast cancer at KPNC during 2004-2007; 2,669 (44.5 %) received at least one chemotherapy infusion at KPNC within 12 months of diagnosis. Factors associated with receiving chemotherapy included <50 years of age [odds ratio (OR) 2.27, 95 % confidence interval (CI) 1.81-2.86], tumor >2 cm (OR 2.14, 95 % CI 1.75-2.61), involved lymph nodes (OR 11.3, 95 % CI 9.29-13.6), hormone receptor-negative (OR 6.94, 95 % CI 4.89-9.86), Her2/neu-positive (OR 2.71, 95 % CI 2.10-3.51), or high grade (OR 3.53, 95 % CI 2.77-4.49) tumors; comorbidities associated inversely with chemotherapy use [heart disease for anthracyclines (OR 0.24, 95 % CI 0.14-0.41), neuropathy for taxanes (OR 0.45, 95 % CI 0.22-0.89)]. Relative to high-socioeconomic status (SES) non-Hispanic Whites, we observed less anthracycline and taxane use by SES non-Hispanic Whites (OR 0.63, 95 % CI 0.49-0.82) and American Indians (OR 0.23, 95 % CI 0.06-0.93), and more anthracycline use by high-SES Asians/Pacific Islanders (OR 1.72, 95 % CI 1.02-2.90). In this equal-access healthcare system, chemotherapy use followed practice guidelines, but varied by race and socio-demographic factors. These findings may inform efforts to optimize quality in breast cancer care.

Original languageEnglish (US)
Pages (from-to)247-260
Number of pages14
JournalBreast Cancer Research and Treatment
Volume137
Issue number1
DOIs
StatePublished - Jan 2013
Externally publishedYes

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Breast Neoplasms
Drug Therapy
Anthracyclines
Social Class
Practice Guidelines
Demography
Delivery of Health Care
Taxoids
Neoplasms
North American Indians
Electronic Health Records
Evidence-Based Practice
Registries
Comorbidity
Heart Diseases
Randomized Controlled Trials
Logistic Models
Lymph Nodes
Regression Analysis
Hormones

Keywords

  • Breast cancer
  • Chemotherapy
  • Disparities
  • Electronic medical record
  • Outcomes research
  • Patterns of care
  • Quality of care

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Patterns and predictors of breast cancer chemotherapy use in Kaiser Permanente Northern California, 2004-2007. / Kurian, Allison W.; Lichtensztajn, Daphne Y.; Keegan, Theresa H; Leung, Rita W.; Shema, Sarah J.; Hershman, Dawn L.; Kushi, Lawrence H.; Habel, Laurel A.; Kolevska, Tatjana; Caan, Bette J.; Gomez, Scarlett L.

In: Breast Cancer Research and Treatment, Vol. 137, No. 1, 01.2013, p. 247-260.

Research output: Contribution to journalArticle

Kurian, AW, Lichtensztajn, DY, Keegan, TH, Leung, RW, Shema, SJ, Hershman, DL, Kushi, LH, Habel, LA, Kolevska, T, Caan, BJ & Gomez, SL 2013, 'Patterns and predictors of breast cancer chemotherapy use in Kaiser Permanente Northern California, 2004-2007', Breast Cancer Research and Treatment, vol. 137, no. 1, pp. 247-260. https://doi.org/10.1007/s10549-012-2329-5
Kurian, Allison W. ; Lichtensztajn, Daphne Y. ; Keegan, Theresa H ; Leung, Rita W. ; Shema, Sarah J. ; Hershman, Dawn L. ; Kushi, Lawrence H. ; Habel, Laurel A. ; Kolevska, Tatjana ; Caan, Bette J. ; Gomez, Scarlett L. / Patterns and predictors of breast cancer chemotherapy use in Kaiser Permanente Northern California, 2004-2007. In: Breast Cancer Research and Treatment. 2013 ; Vol. 137, No. 1. pp. 247-260.
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AU - Hershman, Dawn L.

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N2 - Chemotherapy regimens for early stage breast cancer have been tested by randomized clinical trials, and specified by evidence-based practice guidelines. However, little is known about the translation of trial results and guidelines to clinical practice. We extracted individual-level data on chemotherapy administration from the electronic medical records of Kaiser Permanente Northern California (KPNC), a pre-paid integrated healthcare system serving 29 % of the local population. We linked data to the California Cancer Registry, incorporating socio-demographic and tumor factors, and performed multivariable logistic regression analyses on the receipt of specific chemotherapy regimens. We identified 6,004 women diagnosed with Stage I-III breast cancer at KPNC during 2004-2007; 2,669 (44.5 %) received at least one chemotherapy infusion at KPNC within 12 months of diagnosis. Factors associated with receiving chemotherapy included <50 years of age [odds ratio (OR) 2.27, 95 % confidence interval (CI) 1.81-2.86], tumor >2 cm (OR 2.14, 95 % CI 1.75-2.61), involved lymph nodes (OR 11.3, 95 % CI 9.29-13.6), hormone receptor-negative (OR 6.94, 95 % CI 4.89-9.86), Her2/neu-positive (OR 2.71, 95 % CI 2.10-3.51), or high grade (OR 3.53, 95 % CI 2.77-4.49) tumors; comorbidities associated inversely with chemotherapy use [heart disease for anthracyclines (OR 0.24, 95 % CI 0.14-0.41), neuropathy for taxanes (OR 0.45, 95 % CI 0.22-0.89)]. Relative to high-socioeconomic status (SES) non-Hispanic Whites, we observed less anthracycline and taxane use by SES non-Hispanic Whites (OR 0.63, 95 % CI 0.49-0.82) and American Indians (OR 0.23, 95 % CI 0.06-0.93), and more anthracycline use by high-SES Asians/Pacific Islanders (OR 1.72, 95 % CI 1.02-2.90). In this equal-access healthcare system, chemotherapy use followed practice guidelines, but varied by race and socio-demographic factors. These findings may inform efforts to optimize quality in breast cancer care.

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