title: Examining the use of breast-conserving treatment for women with breast cancer in a managed care environment.
abstract: At a National Institutes of Health Consensus Conference in 1991, conservation treatment was considered preferable for patients with early-stage breast cancer. In the early and mid-1990s, however, less than half of the eligible patients received this treatment and the rates varied with patient and provider characteristics. This study explores whether more eligible patients with breast cancer received conservation treatment in recent years in a managed care environment compared to reports in the literature, and if patient and hospital characteristics affected the rate of acceptance. The study population included 753 women with breast cancer in clinical stages 0, I, or II. Patients with Stage III or IV tumors or with tumors larger that 5.0 cm were excluded. A multiple logistic regression incorporated in a mixed-effect model was used to estimate the effect of patient and facility characteristics on the likelihood of using breast-conserving surgery controlling for clinical stages and demographics such as age, race, and marital status. Among the 753 eligible patients, 474 (62.9%) received conservation surgery. Only Hispanic ethnicity and clinical stage significantly affected the likelihood of receiving conservation treatment. Factors such as patient age, hospital size, and teaching status that had been found to be significant predictors in earlier studies were not statistically significant in this study, although conservation treatment was more frequent in younger women and in teaching hospitals. A larger proportion of eligible patients received conservative treatment in this study than in previous reports. This treatment became available in a broader range of institutions, moving from large, academic teaching centers to smaller community hospitals.
authors.affiliation: Health Benchmarks, Inc., Woodland Hills, CA 91367, USA. alegorreta@healthbenchmarks.com
authors.forename: A P
authors.initials: AP
authors.lastname: Legorreta
authors.forename: X
authors.initials: X
authors.lastname: Liu
authors.forename: R G
authors.initials: RG
authors.lastname: Parker
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000601:surgery*; D002140:California; D005260:Female; D006279:Health Maintenance Organizations / Q000458:organization & administration / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006801:Humans; D007193:Independent Practice Associations / Q000706:statistics & numerical data; D016015:Logistic Models; D008329:Managed Care Programs / Q000706:statistics & numerical data; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data*; D008875:Middle Aged; D014600:Utilization Review