Skip to main content

Advertisement

SpringerLink
Log in

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

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Schmitz KH, Stout NL, Andrews K, et al. Prospective evaluation of physical rehabilitation needs in breast cancer survivors: a call to action. Cancer. 2012;118(8 Suppl):2187–90. https://doi.org/10.1002/cncr.27471.

    Article  PubMed  Google Scholar 

  2. Partridge AH, Winer EP. Long-term complications of adjuvant chemotherapy for early-stage breast cancer. Breast Dis. 2004;21:55–64. https://doi.org/10.3233/bd-2004-21108.

    Article  PubMed  Google Scholar 

  3. Maass SW, Roorda C, Berendsen AJ, et al. The prevalence of long-term symptoms of depression and anxiety after breast cancer treatment: a systematic review. Maturitas. 2015;82(1):100–8.

    Article  CAS  PubMed  Google Scholar 

  4. Heller DR, Killelea BK, Sanft T. Prevention is key: importance of early recognition and referral in combating breast cancer-related lymphedema. J Oncol Pract. 2019;15(5):263–4. https://doi.org/10.1200/JOP.19.00148.

    Article  PubMed  PubMed Central  Google Scholar 

  5. American College of Surgeons. Optimal Resources for Cancer Care 2020 Standards. Chicago, IL, 2019.

  6. American College of Surgeons. National accreditation program for breast centers standards manual 2018 Edition. Chicago, IL, 2017.

  7. Stubblefield MD, Hubbard G, Cheville A, Koch U, Schmitz KH, Dalton SO. Current perspectives and emerging issues on cancer rehabilitation. Cancer. 2013;119:2170–8. https://doi.org/10.1002/cncr.28059.

    Article  PubMed  Google Scholar 

  8. Cheville AL, Troxel AB, Basford JR, Kornblith AB. Prevalence and treatment patterns of physical impairments in patients with metastatic breast cancer. J Clin Oncol. 2008;26(16):2621–9. https://doi.org/10.1200/jco.2007.12.3075.

    Article  PubMed  Google Scholar 

  9. Flores AM, Nelson J, Sowles L, et al. Physical impairments and physical therapy services for minority and low-income breast cancer survivors. SpringerPlus. 2016;5(1):1227. https://doi.org/10.1186/s40064-016-2455-3.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Holm LV, Hansen DG, Larsen PV, et al. Social inequality in cancer rehabilitation: a population-based cohort study. Acta Oncol. 2013;52(2):410–22. https://doi.org/10.3109/0284186X.2012.745014.

    Article  PubMed  Google Scholar 

  11. Hind D, et al. Surgery, with or without tamoxifen vs tamoxifen alone for older women with operable breast cancer: Cochrane review. Br J Cancer. 2007;96(7):1025–9. https://doi.org/10.1038/sj.bjc.6603600.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. U.S. Census Bureau. Quick Facts: New Haven City, Connecticut. Retrieved 20 May 2022 at https://www.census.gov/quickfacts/newhavencityconnecticut.

  13. Commission on Cancer. Facility Oncology Registry Data Standards 2016. USA, American College of Surgeons. 2016.

  14. U.S. Census Bureau. Census Data. Retrieved 20 May 2022 at https://www.census.gov.

  15. World Health Organization. International Classification of Diseases (9th revision), 1979.

  16. World Health Organization. International Classification of Diseases (10th revision), 1999.

  17. Bluethmann SM, Mariotto AB, Rowland JH. Anticipating the “Silver Tsunami”: prevalence trajectories and comorbidity burden among older cancer survivors in the United States. Cancer Epidemiol Biomarkers Prev. 2016;25(7):1029–36. https://doi.org/10.1158/1055-9965.Epi-16-0133.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Cheville AL. Cancer rehabilitation. Semin Oncol. 2005;32(2):219–24. https://doi.org/10.1053/j.seminoncol.2004.11.009.

    Article  PubMed  Google Scholar 

  19. Cheville AL, Beck LA, Petersen TL, et al. The detection and treatment of cancer-related functional problems in an outpatient setting. Support Care Cancer. 2009;17(1):61–7. https://doi.org/10.1007/s00520-008-0461-x.

    Article  CAS  PubMed  Google Scholar 

  20. Movsas SB, Chang VT, Tunkel RS, et al. Rehabilitation needs of an inpatient medical oncology unit. Arch Phys Med Rehabil. 2003;84(11):1642–6. https://doi.org/10.1053/s0003-9993(03)00345-9.

    Article  PubMed  Google Scholar 

  21. Silver JK, Stout NL, Fu JB, et al. The state of cancer rehabilitation in the United States. J Cancer Rehabil. 2018;1:1–8.

    PubMed  PubMed Central  Google Scholar 

  22. Lin YH, Pan PJ. The use of rehabilitation among patients with breast cancer: a retrospective longitudinal cohort study. BMC Health Services Res. 2012;12(1):282. https://doi.org/10.1186/1472-6963-12-282.

    Article  Google Scholar 

  23. Dalton SO, Olsen HM, Moustsen IR, et al. Socioeconomic position, referral, and attendance to rehabilitation after a cancer diagnosis: a population-based study in Copenhagen, Denmark 2010–2015. Acta Oncol. 2019;58(5):730–6. https://doi.org/10.1080/0284186X.2019.1582800.

    Article  Google Scholar 

  24. Elmore JG, Moceri VM, Carter D, Larson EB. Breast carcinoma tumor characteristics in black and white women. Cancer. 1998;83:2509–15.

    Article  CAS  PubMed  Google Scholar 

  25. Li CI, Malone KE, Daling JR. Differences in breast cancer stage, treatment, and survival by race and ethnicity. Arch Intern Med. 2003;163(1):49–56. https://doi.org/10.1001/archinte.163.1.49.

    Article  PubMed  Google Scholar 

  26. Williams F, Thompson E. Disparities in breast cancer stage at diagnosis: importance of race, poverty, and age. J Health Dispar Res Pract. 2017;10(3):34–45.

    PubMed  PubMed Central  Google Scholar 

  27. Montagna G, Zhang J, Sevilimedu V, et al. Risk factors and racial and ethnic disparities in patients with breast cancer-related lymphedema. JAMA Oncol. 2022;8(8):1195–200. https://doi.org/10.1001/jamaoncol.2022.1628.

    Article  PubMed  PubMed Central  Google Scholar 

  28. DiSipio T, Rye S, Newman B, Hayes S. Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol. 2013;14(6):500–15. https://doi.org/10.1016/s1470-2045(13)70076-7.

    Article  PubMed  Google Scholar 

  29. U.S. Census Bureau. Quick Facts: United States. Retrieved 20 May 2022 at https://www.census.gov/quickfacts/fact/table/US/PST045221.

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Surgery, Yale University School of Medicine, New Haven, CT, USA

    Vernice H. Y. Chan MBBS, Danielle R. Heller MD, MHS, Elizabeth R. Berger MD, MS & Rachel A. Greenup MD, MPH

  2. Yale Cancer Center, Yale University School of Medicine, New Haven, CT, USA

    Scott Capozza MS, PT

  3. Department of Medical Oncology, Yale University School of Medicine, New Haven, CT, USA

    Tara B. Sanft MD

Authors
  1. Vernice H. Y. Chan MBBS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Danielle R. Heller MD, MHS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elizabeth R. Berger MD, MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Scott Capozza MS, PT
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rachel A. Greenup MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tara B. Sanft MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tara B. Sanft MD.

Ethics declarations

There are no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 16 kb)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chan, V.H.Y., Heller, D.R., Berger, E.R. et al. Ancillary Treatment Referrals and Visits After Breast Cancer Surgery in a Sociodemographically Diverse Population. Ann Surg Oncol 30, 5637–5648 (2023). https://doi.org/10.1245/s10434-023-13431-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-023-13431-5

Search

Navigation