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Breast conservation rates-barriers between tertiary care and community practice
Carol A Hahn1, Lawrence B Marks, David Y Chen
1Duke University Medical Center, Durham, NC 27710, USA. hahn@radonc.duke.edu
Summary
Opening an on-site radiotherapy clinic significantly increased breast conservation therapy (BCT) rates in a North Carolina community hospital. This improvement in BCT for breast cancer occurred despite prior access to distant radiotherapy services.
Area of Science:
- Oncology
- Surgical Oncology
- Radiotherapy
Background:
- Low rates of breast conservation therapy (BCT) are prevalent in the southern United States.
- Access to radiotherapy (RT) services is a critical factor influencing BCT utilization.
Purpose of the Study:
- To evaluate the impact of establishing an on-site radiotherapy clinic on BCT rates within a community hospital setting.
- To determine if local RT availability influences the choice between mastectomy and BCT for breast cancer patients.
Main Methods:
- Retrospective review of a community hospital's pathology database for patients treated for invasive breast malignancy or ductal carcinoma in situ between 1994-1995 and 1997-1998.
- Comparison of BCT rates before (1994-1995) and after (1997-1998) the 1996 opening of an on-site RT clinic.
- Logistic regression analysis to assess the statistical significance of treatment era on BCT utilization.
Main Results:
- The BCT rate at the community hospital increased from 29% in 1994-1995 to 44% in 1997-1998.
- Treatment era was a statistically significant factor influencing the choice of surgical procedure (p <0.001).
- A total of 586 patients were included in the analysis.
Conclusions:
- Establishing an on-site radiotherapy facility at a community hospital led to a significant increase in breast conservation therapy utilization.
- Local RT availability can overcome previous barriers to BCT, even when external services are geographically accessible.