Nearly a Third of Patients With Breast Cancer Who Need Breast-Conserving Surgery Bypass Local Care

Patients with breast cancer (BC) are more likely to receive care from hospitals classified as specialist breast reconstruction centers, according to study authors who published their findings from a national, population-based study in CANCER.¹ The UK-based study identified certain groups of patients who are willing to drive farther to receive care from specialized centers or surgeons who are reputable on media platforms, however investigators do not know if the clinical outcomes are better at these hospitals.²

“It is important to improve this disconnect between perceived and actual cancer treatment quality because, otherwise, it has the potential [to] create perverse incentives… without necessarily affecting patient outcomes,” study authors wrote in the article.²

Investigators of a recent study evaluated how patients with BC choose a surgery location, also looking at the effect of location policies on health system inequalities. The team used the National Health Service (NHS) database to identify women diagnosed with BC (between 2016 to 2018) who had breast-conserving surgery (n=69,153) or a mastectomy (n=23,536).^1,2

Among the breast-conserving surgery cohort, 32.7% of patients did not go to their nearest hospital for care. Among the mastectomy cohort, 30.5% of patients travelled further from their nearest hospital to receive care. Younger women, those who are White, without additional medical conditions, or living in rural areas were more likely to travel a further distance to receive care, according to the study authors.²

Among the breast-conserving surgery cohort, 32.7% of patients did not go to their nearest hospital for care. Image Credit: © Dorde - stock.adobe.com

Some of the factors that influenced treatment decision may include²:

• Specialization classification. Hospitals classified as specialist breast reconstruction centers were preferred, even though some patients did not need to have breast reconstruction after surgery.
• Media reputation. Surgeons who promoted their reputation for breast cancer surgery on media platforms drew the attention of women who had a mastectomy and immediate breast reconstruction. In turn, patients were more willing to travel to the hospitals with these practitioners.
• Surgery wait time. Patients were not as likely to choose a hospital for treatment if there were shorter surgical waiting times.

There were certain factors that did not influence patient decision-making, which include the amount of research activity at the hospital, the quality of the hospital, rate of breast re-operations, or the hospital’s multidisciplinary status.²

Older patients, patients with comorbidities, and patients from ethnic or minority backgrounds were less likely to travel to a specialist center and more likely to receive care at their local hospital. These local hospitals are more likely to have centralized, unspecialized services, and patients might not be going to recommended or better-quality places of care.²

“As marginalized groups already face barriers to high-quality care, it is important for policy makers to consider measures that mitigate against the risks of increasing inequalities in access and outcomes, by for example providing free transport, accommodation, or even protection against loss of income,” said study co-author Lu Han, PhD, a research fellow at the London School of Hygiene & Tropical Medicine, in a press release. “Moreover, patients prefer to access information on the quality of breast cancer care of the hospitals in their region at the start of the management pathway when a diagnosis is sought. Such information should be easy to understand and presented in a format that can support the trade-offs that patients have to make.”¹

REFERENCES

1. Where do patients choose to undergo breast cancer surgery, and do these choices drive health care inequality? Wiley. News Release. January 8, 2024. Accessed on January 11, 2024. https://www.eurekalert.org/news-releases/1030214
2. Aggarwal A, Han L, Lewis D, et al. Association of travel time, patient characteristics, and hospital quality with patient mobility for breast cancer surgery: A national population-based study. CANCER. January 8, 2024;doi: 10.1002/cncr.35153