title: Influence of patient, physician, and hospital characteristics on the receipt of guideline-concordant care for inflammatory breast cancer.
abstract: OBJECTIVE
  Inflammatory breast cancer (IBC) is an aggressive subtype of breast cancer for which treatments vary, so we sought to identify factors that affect the receipt of guideline-concordant care.
  
  
  METHODS
  Patients diagnosed with IBC in 2004 were identified from the Breast and Prostate Cancer Data Quality and Patterns of Care Study, containing information from cancer registries in seven states. Variation in guideline-concordant care for IBC, based on National Comprehensive Cancer Network (NCCN) guidelines, was assessed according to patient, physician, and hospital characteristics.
  
  
  RESULTS
  Of the 107 IBC patients in the study without distant metastasis at the time of diagnosis, only 25.8% received treatment concordant with guidelines. Predictors of non-concordance included patient age (≥70 years), non-white race, normal body mass index (BMI 18.5-25 kg/m(2)), patients with physicians graduating from medical school >15 years prior, and smaller hospital size (<200 beds). IBC patients survived longer if they received guideline-concordant treatment based on either 2003 (p=0.06) or 2013 (p=0.06) NCCN guidelines.
  
  
  CONCLUSIONS
  Targeting factors associated with receipt of care that is not guideline-concordant may reduce survival disparities in IBC patients. Prompt referral for neoadjuvant chemotherapy and post-operative radiation therapy is also crucial.
authors.affiliation: Medical Scientist Training Program, University of Wisconsin-Madison, 6068 WIMR, 1111 Highland Avenue, Madison, WI 53705, USA.
authors.forename: Ryan A
authors.initials: RA
authors.lastname: Denu
authors.affiliation: University of Wisconsin-Madison Carbone Cancer Center, 610 Walnut Street, Room 307, WARF Building, Madison, WI 53726, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Hampton
authors.affiliation: Department of Radiation Oncology, Medical College of Wisconsin, 8701W Watertown Plank Rd, Milwaukee, WI 53226, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Currey
authors.affiliation: Division of Health Services Research, College of Medicine, Pennsylvania State University, 500 University Drive, Hershey, PA 17033, USA.
authors.forename: Roger T
authors.initials: RT
authors.lastname: Anderson
authors.affiliation: Public Health Institute, Cancer Registry of Greater California, Department of Public Health Sciences, UC Davis School of Medicine, One Shields Avenue, Medical Sciences 1C, Davis, CA 95616, USA.
authors.forename: Rosemary D
authors.initials: RD
authors.lastname: Cress
authors.affiliation: College of Public Health, University of Kentucky, 111 Washington Avenue, Lexington, KY 40536, USA.
authors.forename: Steven T
authors.initials: ST
authors.lastname: Fleming
authors.affiliation: Rollins School of Public Health and Winship Cancer Institute, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Lipscomb
authors.affiliation: Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
authors.forename: Susan A
authors.initials: SA
authors.lastname: Sabatino
authors.affiliation: LSU Health Sciences Center School of Public Health, 2020 Gravier Street, 3rd Floor, New Orleans, LA 70112, USA.
authors.forename: Xiao-Cheng
authors.initials: XC
authors.lastname: Wu
authors.affiliation: Department of Radiation Oncology, Medical College of Wisconsin, 8701W Watertown Plank Rd, Milwaukee, WI 53226, USA.
authors.forename: J Frank
authors.initials: JF
authors.lastname: Wilson
authors.affiliation: Department of Population Health Sciences, Carbone Cancer Center, University of Wisconsin-Madison, 610 Walnut Street, Room 307, WARF Building, Madison, WI 53726, USA. Electronic address: trentham@wisc.edu.
authors.forename: Amy
authors.initials: A
authors.lastname: Trentham-Dietz
mesh_terms: D000368:Aged; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D017408:Guidelines as Topic / Q000592:standards*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D058922:Inflammatory Breast Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D008495:Medical Oncology / Q000592:standards* / Q000706:statistics & numerical data*; D008875:Middle Aged; D010820:Physicians / Q000706:statistics & numerical data
keywords: Breast cancer; Epidemiology; Guideline; Healthcare disparities; Inflammatory breast cancer