Rural breast cancer treatment: evidence from the Reaching Communities for Cancer Care (REACH) project.
BACKGROUND
Research shows that rural populations are more likely than their urban counterparts to be diagnosed with late-stage cancer, but less is known about appropriateness of cancer treatment in rural locations after diagnosis. The objective of this analysis was to assess the degree to which rural breast cancer treatment was received in concordance with national recommendations.


METHODS
Data came from 251 stage I and II breast cancer patients residing in rural North Carolina. State-of-the-art care was defined using the National Cancer Institute's (NCI) physician data query (PDQ) database, and cases were categorized into appropriate primary and/or adjuvant treatment. Chi-square and Fishers' exact tests were used to assess changes in appropriate treatment over time (1991-1996) and between stage. Multiple logistic regression was used to determine whether any patient or disease characteristics were associated with receipt of appropriate treatment.


RESULTS
Most (81-90%) of the breast cancer cases received the appropriate primary therapy (mastectomy or lumpectomy followed by radiation therapy); of these, the majority received a mastectomy (66-72%). Fewer women received adjuvant therapy as recommended (27-61%), although significantly more stage II than stage I cases did so (p < or = 0.05). Regression showed that stage and estrogen-receptor (ER) status were associated with appropriate therapy.


CONCLUSIONS
The findings suggest that there exist deviations from NCI established treatment recommendations among rural breast cancer patients. More research is needed to develop better methods for dissemination of state-of-the-art cancer information to rural physicians and patients, and to understand how treatment decisions are made.
Tropman
S E
SE
Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, USA.
Ricketts
T C
TC
Paskett
E
E
Hatzell
T A
TA
Cooper
M R
MR
Aldrich
T
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D003657:Decision Making; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007255:Information Services; D008875:Middle Aged; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D011960:Receptors, Estrogen / Q000032:analysis; D019035:Rural Health Services / Q000592:standards*; D012424:Rural Population
D011960:Receptors, Estrogen