title: Variations in Guideline-Concordant Breast Cancer Adjuvant Therapy in Rural Georgia.
abstract: OBJECTIVE
  To examine factors associated with guideline-concordant adjuvant therapy among breast cancer patients in a rural region of the United States and to present an advancement in quality-of-care assessment in the context of multiple treatments.
  
  
  METHODS
  Chart abstraction on initial therapy received by 868 women diagnosed with primary, invasive, early-stage breast cancer in a largely rural region of southwest Georgia.
  
  
  METHODS
  Using multivariable logistic regression, we examined predictors of adjuvant chemo-, radiation, and hormonal therapy regimens defined as guideline-concordant according to the 2000 National Institutes of Health Consensus Development Conference Statement.
  
  
  RESULTS
  Overall, 35.2 percent of women received guideline-concordant care for all three adjuvant therapies. Higher socioeconomic status was associated with receiving guideline-concordant care for all three adjuvant therapies jointly, and for chemotherapy. Compared with private insurance, having Medicaid was associated with guideline-concordant chemotherapy. Unmarried women were more likely to be nonconcordant for chemotherapy and radiation therapy. Increased age predicted nonconcordance for adjuvant therapies jointly, for chemotherapy, and for hormonal therapy.
  
  
  CONCLUSIONS
  A number of factors were independently associated with receiving guideline-concordant adjuvant therapy. Identifying and addressing factors that lead to nonconcordance may reduce disparities in treatment and survival.
authors.affiliation: Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Chamblee, GA.
authors.forename: Gery P
authors.initials: GP
authors.lastname: Guy
authors.affiliation: Department of Health Policy and Management, Rollins School of Public Health, Winship Cancer Institute, Emory University, Atlanta, GA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Lipscomb
authors.affiliation: Department of Surgery, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA.
authors.forename: Theresa W
authors.initials: TW
authors.lastname: Gillespie
authors.affiliation: Department of Health Policy and Management, Rollins School of Public Health, Winship Cancer Institute, Emory University, Atlanta, GA.
authors.forename: Michael
authors.initials: M
authors.lastname: Goodman
authors.affiliation: Division of Blood Disorders, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Richardson
authors.affiliation: Department of Health Policy and Management, Rollins School of Public Health, Winship Cancer Institute, Emory University, Atlanta, GA.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Ward
mesh_terms: D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000628:therapy*; D003131:Combined Modality Therapy / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D005845:Georgia; D019983:Guideline Adherence; D006801:Humans; D008484:Medicaid / Q000706:statistics & numerical data; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D012424:Rural Population; D012959:Socioeconomic Factors; D014481:United States
keywords: Quality assessment; breast cancer; cancer care; quality of care; rural health