Variations in outcomes by residential location for women with breast cancer: a systematic review

Abstract

ObjectivesTo systematically assess the evidence for variations in outcomes at each step along the breast cancer continuum of care for Australian women by residential location.DesignSystematic review.MethodsSystematic searches of peer-reviewed articles in English published from 1 January 1990 to 24 November 2017 using PubMed, EMBASE, CINAHL and Informit databases. Inclusion criteria were: population was adult female patients with breast cancer; Australian setting; outcome measure was survival, patient or tumour characteristics, screening rates or frequencies, clinical management, patterns of initial care or post-treatment follow-up with analysis by residential location or studies involving non-metropolitan women only. Included studies were critically appraised using a modified Newcastle–Ottawa Scale.ResultsSeventy-four quantitative studies met the inclusion criteria. Around 59% were considered high quality, 34% moderate and 7% low. No eligible studies examining treatment choices or post-treatment follow-up were identified. Non-metropolitan women consistently had poorer survival, with most of this differential being attributed to more advanced disease at diagnosis, treatment-related factors and socioeconomic disadvantage. Compared with metropolitan women, non-metropolitan women were more likely to live in disadvantaged areas and had differing clinical management and patterns of care. However, findings regarding geographical variations in tumour characteristics or diagnostic outcomes were inconsistent.ConclusionsA general pattern of poorer survival and variations in clinical management for Australian female patients with breast cancer from non-metropolitan areas was evident. However, the wide variability in data sources, measures, study quality, time periods and geographical classification made direct comparisons across studies challenging. The review highlighted the need to promote standardisation of geographical classifications and increased comparability of data systems. It also identified key gaps in the existing literature including a lack of studies on advanced breast cancer, geographical variations in treatment choices from the perspective of patients and post-treatment follow-up.

Global Trends in Incidence Rates of Primary Adult Liver Cancers: A Systematic Review and Meta-Analysis

“…A modified (14) version of the Newcastle-Ottawa Scale (NOS) (15), a risk-of-bias assessment tool for nonrandomized studies, was used for quality assessment. Studies were scored according to the extent that they met each of the nine assessed criteria using an ordinal scale to rate the risk of bias as 0 (high), 1 (intermediate), and 2 (low).…”

Factors influencing breast cancer outcomes in Australia: A systematic review

“…Previous reviews (Dasgupta et al, 2017(Dasgupta et al, ,2018Lyle et al, 2017;Tapia et al, 2017;Youl et al, 2016) focus on specific groups of women with breast cancer in Australia. To the knowledge of the review authors, this is the first review that takes a holistic approach to explore all the proposed factors cited in the literature that contribute to poorer breast cancer outcomes in Australia, including tumour characteristics, patient characteristics (Indigenous status, ethnic minority groups, place of residence, and socioeconomic status) and treatment characteristics.…”

“…Two provided strong evidence that Indigenous women had poorer survival outcomes than non‐Indigenous women due to more extensive disease at diagnosis, delays in diagnosis and/or treatment, geographical isolation, higher comorbidity burden, socioeconomic disadvantage and limited access to surgical treatment (Dasgupta et al, ; Tapia et al, ). Another review demonstrated consistently poorer survival for geographically isolated women, attributing this largely to more advanced disease at diagnosis, treatment‐related factors and socioeconomic disadvantage (Dasgupta et al, ). These characteristics were reflected in another review which explored the psychosocial outcomes for women with breast cancer.…”

“…Five reviews were identified which explored breast cancer outcomes in Australia (Dasgupta et al, 2017(Dasgupta et al, ,2018Lyle, Hendrie, & Hendrie, 2017;Tapia et al, 2017;Youl et al, 2016). Two provided strong evidence that Indigenous women had poorer survival outcomes than non-Indigenous women due to more extensive disease at diagnosis, delays in diagnosis and/or treatment, geographical isolation, higher comorbidity burden, socioeconomic disadvantage and limited access to surgical treatment (Dasgupta et al, 2017;Tapia et al, 2017).…”

Emerging cancer incidence, mortality, hospitalisation and associated burden among Australian cancer patients, 1982 – 2014: an incidence-based approach in terms of trends, determinants and inequality

“…There are several factors which lead to increased breast cancer incidence and cancer-related mortality. These can be classified into patients, tumour and treatment characteristics 83–85. These characteristics include patient age, ethnicity, tumour type, size, grade, stage, hormone receptor status, type of surgery and the use of adjuvant therapies 83–85.…”