Comorbidity Burden and Guideline-Concordant Care for Breast Cancer

Details

• Alternative Title:
  J Am Geriatr Soc
• Personal Author:
  Kimmick, Gretchen ; Fleming, Steven T. ; Sabatino, Susan A. ; Wu, Xiao-Cheng ; Hwang, Wenke ; Wilson, J. Frank ; Lund, Mary Jo ; Cress, Rosemary ; Anderson, Roger T.
• Description:
  OBJECTIVES
  
  To explore the relationship between level and type of comorbidity and guideline-concordant care for early-stage breast cancer.
  
  DESIGN
  
  Cross-sectional.
  
  SETTING
  
  National Program of Cancer Registry (NPCR) Breast and Prostate Cancer Patterns of Care study, which re-abstracted medical records from 2004 in seven cancer registries.
  
  PARTICIPANTS
  
  Individuals with stage 0–III breast cancer.
  
  MEASUREMENTS
  
  Multicomponent guideline-concordant management was modeled based on tumor size, node status, and hormone receptor status, according to consensus guidelines. Comorbid conditions and severity were measured using the Adult Comorbidity Evaluation Index (ACE-27). Multivariate logistic regression models determined factors associated with guideline-concordant care and included overall ACE-27 scores and 26 separate ACE comorbidity categories, age, race, stage, and source of payment.
  
  RESULTS
  
  The study sample included 6,439 women (mean age 58.7, range 20–99; 76% white; 44% with no comorbidity; 70% estrogen- or progesterone-receptor positive, or both; 31% human epidermal growth factor receptor 2 positive). Care was guideline concordant in 60%. Guideline concordance varied according to overall comorbidity burden (70% for none; 61% for minor; 58% for moderate, 43% for severe; P < .05). In multivariate analysis, the presence of hypertension (odds ratio (OR) = 1.15, 95% confidence interval (CI) = 1.01–1.30) predicted guideline concordance, whereas dementia (OR = 0.45, 95% CI = 0.24–0.82) predicted lack of guideline concordance. Older age (≥50) and black race were associated with less guideline concordance, regardless of comorbidity level.
  
  CONCLUSION
  
  When reporting survival outcomes in individuals with breast cancer with comorbidity, adherence to care guidelines should be among the covariates.
  
  
• Subjects:
  Aged Article Breast Cancer Breast Neoplasms Comorbidity Delivery Of Health Care Female Guideline Adherence Guideline Concordance Humans Middle Aged Neoplasm Staging Prognosis Retrospective Studies SEER Program United States

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• Source:
  J Am Geriatr Soc. 62(3):482-488
• Pubmed ID:
  24512124
• Pubmed Central ID:
  PMC5869701
• Document Type:
  Journal Article
• Funding:
  U01 DP000261/DP/NCCDPHP CDC HHS/United States ; U01 DP000258/DP/NCCDPHP CDC HHS/United States ; U01 DP000251/DP/NCCDPHP CDC HHS/United States ; 1-U01-DP000264/DP/NCCDPHP CDC HHS/United States ; U01 DP000264/DP/NCCDPHP CDC HHS/United States ; U01 DP000259/DP/NCCDPHP CDC HHS/United States ; U01 DP000260/DP/NCCDPHP CDC HHS/United States ; 1-U01-DP000259/DP/NCCDPHP CDC HHS/United States ; 1-U01-DP000258/DP/NCCDPHP CDC HHS/United States ; CC999999/Intramural CDC HHS/United States ; 1-U01-DP000261/DP/NCCDPHP CDC HHS/United States ; U01 DP000253/DP/NCCDPHP CDC HHS/United States ; 1-U01-DP000253/DP/NCCDPHP CDC HHS/United States ; 1-U01-DP000251/DP/NCCDPHP CDC HHS/United States ; 1-U01-DP000260/DP/NCCDPHP CDC HHS/United States
• Volume:
  62
• Issue:
  3
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:fc16ea690572de2434ca550861e72f14fdf353d7789c72ed389bdaf31ec26730
• Download URL:
  https://stacks.cdc.gov/view/cdc/52836/cdc_52836_DS1.pdf
• File Type:
  [PDF - 103.56 KB ]