Fragmentation of care in breast cancer: greater than the sum of its parts

• DOI: 10.1007/s10549-024-07442-3
• Publication Date: 2024-08-03T14:01:53Z
• Authors: Hadley D. Freeman; Linnea C. Burke; Ja’Neil G. Humphrey; Ashley J. Wilbers; Halley Vora; Rhami Khorfan; Naveenraj L. Solomon; Jukes P. Namm; Liang Ji; Sharon S. Lum
• Keywords: Adult; Research; Breast Neoplasms; Kaplan-Meier Estimate; Middle Aged; Time-to-Treatment; 03 medical and health sciences; 0302 clinical medicine; Humans; Female; Retrospective Studies; Aged; Neoplasm Staging

Abstract Introduction Fragmentation of care (FC, the receipt at > 1 institution) has been shown to negatively impact cancer outcomes. Given multimodal nature breast treatment, we sought identify factors associated with FC and its effects on survival patients. Methods A retrospective analysis was performed surgically treated, stage I–III patients in 2004–2020 National Cancer Database, excluding neoadjuvant therapy recipients. Patients were stratified into two groups: or non-FC care. Treatment delay defined as definitive surgery 60 days after diagnosis. Multivariable logistic regression predictive FC, compared using Kaplan–Meier multivariable Cox proportional hazards methods. Results Of 531,644 identified, 340,297 (64.0%) received FC. After adjustment, (OR 1.27, 95% CI 1.25–1.29) independently treatment delay. Factors included Hispanic ethnicity 1.04, CI: 1.01–1.07), comprehensive community programs 1.06, 1.03–1.08) integrated network 1.55, 1.51–1.59), AJCC II 1.05–1.07) III tumors 1.02–1.10), HR + /HER2 1.05, 1.02–1.07). increased risk mortality (HR 1.23, 1.20–1.26), whereas 0.87, 0.86–0.88) showed benefit. Conclusions While impacts patients, our findings suggest could be a marker for multispecialty that may mitigate some these effects.