Spatial barriers impact upon appropriate delivery of radiotherapy in breast cancer patients

Abstract

Radiotherapy (RT) is the standard treatment for breast cancer patients after conserving surgery or mastectomy when patients are at high risk of relapse. Major obstacles to appropriate RT delivery are journey times. Since studies on access to RT were carried out mostly in large countries, this study investigated factors in an Italian region and the influence of RT delivery on survival. A total of 4735 female candidates for RT were included in the study. A geographic information system calculated journey times from patients' homes and surgery hospitals to RT centers. Logistic regression analyzed the influence of journey times, socioeconomic status, and other factors on RT delivery. Survival probabilities and excess mortality were assessed in 4364 propensity score-matched patients. Journey times of 40 min or less from residence and from surgery hospital to RT center played a major role in access to RT. A large survival difference emerged between treated and untreated breast cancer patients. The excess mortality for untreated patients compared with propensity score-matched women receiving RT was 3.1 (95% CI: 2.2–4.3). Expansion of RT facilities during the 11-year study period improved RT delivery and outcomes by increasing availability but mainly by shortening journey times.

This is the first European study to investigate the impact of spatial barriers upon appropriate radiotherapy (RT) in breast cancer patients. In Umbria, central Italy, journey times >40 min significantly decreased the probability of receiving RT and were consequently associated with poor outcome. New RT centers provided more patients with appropriate treatment, raising the issue of a "hub and spoke" approach. Spatial barriers to RT in Europe deserve investigation.

http://ift.tt/2rwniVa