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European Journal of Epidemiology
Published in: European Journal of Epidemiology 11/2012

01-11-2012 | CANCER

Survival from breast cancer in relation to access to tertiary healthcare, body mass index, tumor characteristics and treatment: a Hellenic Cooperative Oncology Group (HeCOG) study

Authors: Paraskevi Panagopoulou, Helen Gogas, Nick Dessypris, Nikos Maniadakis, George Fountzilas, Eleni Th. Petridou

Published in: European Journal of Epidemiology | Issue 11/2012

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Abstract

Apart from tumour, treatment and patient characteristics at diagnosis, access to healthcare delivery may as well play a significant role in breast cancer prognosis. This study aimed to assess the additional impact exerted on survival by travel burden—a surrogate indicator of limited access to healthcare- expressed as geographical distance and/or time needed to reach the tertiary healthcare center from the patient’s residence. Between 1997 and 2005, 2,789 women participated in therapeutic clinical trials conducted by the Hellenic Cooperative Oncology Group. The effect of geographical distance and travel time between patient’s residence and treating hospital on survival was estimated using Cox proportional hazards regression adjusting for age, menopausal status, tumour size/grade, positive nodes (number), hormonal receptor status, HER2 overexpression, surgery type/treatment protocol as well as for body mass index >30 kg/m2. More aggressive tumour features, older treatment protocols and modifiable patient characteristics, such as obesity (HR: 1.27) adversely impacted on breast cancer survival. In addition, less studied indicators of access to healthcare, such as geographic distance >350 km and travel time >4 h were independently and significantly associated with worse outcomes (HR = 1.43 and 1.34 respectively). In conclusion, to address inequalities in breast cancer survival, improvements in access to healthcare services related to increased travel burden especially for patients of lower socioeconomic status should be considered, more than ever at times of financial crisis and independently of already known modifiable patient characteristics.
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Metadata
Title
Survival from breast cancer in relation to access to tertiary healthcare, body mass index, tumor characteristics and treatment: a Hellenic Cooperative Oncology Group (HeCOG) study
Authors
Paraskevi Panagopoulou
Helen Gogas
Nick Dessypris
Nikos Maniadakis
George Fountzilas
Eleni Th. Petridou
Publication date
01-11-2012
Publisher
Springer Netherlands
Published in
European Journal of Epidemiology / Issue 11/2012
Print ISSN: 0393-2990
Electronic ISSN: 1573-7284
DOI
https://doi.org/10.1007/s10654-012-9737-z

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