title: Treatment patterns among breast cancer patients in the United States using two national surveys on visits to physicians' offices and hospital outpatient departments.
abstract: BACKGROUND
  Despite the availability of previous studies, little research has examined how types of anti-neoplastic agents prescribed differ among various populations and health care characteristics in ambulatory settings, which is a primary method of providing care in the U.S. Understanding treatment patterns can help identify possible disparities and guide practice or policy change.
  
  
  OBJECTIVE
  To characterize patterns of anti-neoplastic agents prescribed to breast cancer patients in ambulatory settings and identify factors associated with receipt of treatment.
  
  
  METHODS
  A cross-sectional analysis using the National Ambulatory Medical Care Survey data in 2006-2010 was conducted. Breast cancer treatments were categorized by class and further grouped as chemotherapy, hormone, and targeted therapy. A visit-level descriptive analysis using visit sampling weights estimated national prescribing trends (n = 2746 breast cancer visits, weighted n = 28,920,657). Multiple logistic regression analyses identified factors associated with anti-neoplastic agent used.
  
  
  RESULTS
  The proportion of visits in which anti-neoplastic agent(s) was/were documented remained stable from 2006 to 2010 (20.47% vs. 24.56%; P > 0.05). Hormones were commonly prescribed (29.69%) followed by mitotic inhibitors (9.86%) and human epidermal growth factor receptor2 inhibitors (5.34%). Patients with distant stage were more likely than patients with in-situ stage to receive treatment (Adjusted Odds Ratio [OR] = 2.79; 95% CI, 1.04-7.77), particularly chemotherapy and targeted therapy. Patients with older age, being ethnic minorities, having comorbid depression, and having U.S. Medicaid insurance were less likely to receive targeted therapy (P < 0.05). Patients with older age, having comorbid obesity and osteoporosis were less likely to receive chemotherapy, while patients seen in hospital-based settings and settings located in metropolitan areas were more likely to receive chemotherapy (P < 0.05).
  
  
  CONCLUSIONS
  Anti-neoplastic treatment patterns differ among breast cancer patients treated in ambulatory settings. Factors predicting treatment include certain socio-demographics, cancer stages, comorbidities, metropolitan areas, and setting.
authors.affiliation: Department of Health Outcomes Research and Policy, Auburn University Harrison School of Pharmacy, 020 James E Foy Hall, Auburn, AL 36849-5506, USA. Electronic address: szw0022@tigermail.auburn.edu.
authors.forename: Saranrat
authors.initials: S
authors.lastname: Wittayanukorn
authors.affiliation: Auburn University, Harrison School of Pharmacy, USA.
authors.forename: Jingjing
authors.initials: J
authors.lastname: Qian
authors.affiliation: Auburn University, Harrison School of Pharmacy, USA.
authors.forename: Salisa C
authors.initials: SC
authors.lastname: Westrick
authors.affiliation: Auburn University, College of Sciences and Mathematics, USA.
authors.forename: Nedret
authors.initials: N
authors.lastname: Billor
authors.affiliation: East Alabama Medical Center, USA; Department of Internal Medicine, Edward via College of Osteopathic Medicine, AL, USA.
authors.forename: Brandon
authors.initials: B
authors.lastname: Johnson
authors.affiliation: Auburn University, Harrison School of Pharmacy, USA.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Hansen
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D010045:Outpatients / Q000706:statistics & numerical data; D010824:Physicians' Offices / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014481:United States
chemical_list: D000970:Antineoplastic Agents
keywords: Ambulatory care; Breast cancer; Chemotherapy; Disparities; Prescribing pattern