title: Access to Care in Vermont: Factors Linked With Time to Chemotherapy for Women With Breast Cancer-A Retrospective Cohort Study.
abstract: In the rural United States, there are multiple potential barriers to the timely initiation of chemotherapy. The goal of this study was to identify factors associated with delays in the time from initial diagnosis to first systemic therapy (TTC) among women with breast cancer in Vermont.
  
  
  
  Using data from the Vermont Cancer Registry, we explored TTC for 702 female Vermont residents diagnosed with stage I to III breast cancer between 2006 and 2010 who received adjuvant chemotherapy. Multivariable linear regression was used to evaluate the associations between TTC and patient, tumor, treatment, and geographic variables.
  
  
  
  Mean TTC was 10.2 weeks. Longer drive time (P < .001), more invasive surgery (P = .01), and breast reconstruction (P < .001) were each associated with longer TTC. Each additional 15 minutes of drive time was associated with a 0.34-week (95% CI, 0.22 to 0.46 weeks) increase in TTC. Participants age younger than 65 years whose primary payer was Medicare (n = 27) had significantly longer average TTC, by 2.37 weeks (P = .001), compared with those with private or military insurance. There was also substantial variation in TTC across hospitals (P < .001).
  
  
  
  Most female patients with stage I to III breast cancer in Vermont are receiving adjuvant chemotherapy within the National Comprehensive Cancer Network-recommended timeframe; however, improvements remain needed for certain subgroups. Novel approaches for women with long drive times need to be developed and evaluated in the community. Variation in TTC by hospital, even after adjusting for patient, tumor, and treatment factors, also suggests opportunities for process improvement.
authors: Vermont Department of Health; University of Vermont Medical Center; University of Vermont Cancer Center, Burlington; and Vermonters Taking Action Against Cancer, Williston, VT alison.johnson@vermont.gov.
authors: Ali
authors: A
authors: Johnson
authors: Vermont Department of Health; University of Vermont Medical Center; University of Vermont Cancer Center, Burlington; and Vermonters Taking Action Against Cancer, Williston, VT.
authors: Leanne
authors: L
authors: Shulman
authors: Vermont Department of Health; University of Vermont Medical Center; University of Vermont Cancer Center, Burlington; and Vermonters Taking Action Against Cancer, Williston, VT.
authors: Jennifer
authors: J
authors: Kachajian
authors: Vermont Department of Health; University of Vermont Medical Center; University of Vermont Cancer Center, Burlington; and Vermonters Taking Action Against Cancer, Williston, VT.
authors: Brian L
authors: BL
authors: Sprague
authors: Vermont Department of Health; University of Vermont Medical Center; University of Vermont Cancer Center, Burlington; and Vermonters Taking Action Against Cancer, Williston, VT.
authors: Farrah
authors: F
authors: Khan
authors: Vermont Department of Health; University of Vermont Medical Center; University of Vermont Cancer Center, Burlington; and Vermonters Taking Action Against Cancer, Williston, VT.
authors: Ted
authors: T
authors: James
authors: Vermont Department of Health; University of Vermont Medical Center; University of Vermont Cancer Center, Burlington; and Vermonters Taking Action Against Cancer, Williston, VT.
authors: David
authors: D
authors: Cranmer
authors: Vermont Department of Health; University of Vermont Medical Center; University of Vermont Cancer Center, Burlington; and Vermonters Taking Action Against Cancer, Williston, VT.
authors: Peter
authors: P
authors: Young
authors: Vermont Department of Health; University of Vermont Medical Center; University of Vermont Cancer Center, Burlington; and Vermonters Taking Action Against Cancer, Williston, VT.
authors: Ruth
authors: R
authors: Heimann
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000453:epidemiology; D017024:Chemotherapy, Adjuvant; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D014707:Vermont / Q000453:epidemiology
chemical_list: D000970:Antineoplastic Agents