The Association Between Oncology Outreach and Timely Treatment for Rural Patients with Breast Cancer: A Claims-Based Approach

• Published in: Annals of surgical oncology Vol. 31; no. 7; pp. 4349 - 4360
• Main Authors: Scodari, Bruno T., Schaefer, Andrew P., Kapadia, Nirav S., Brooks, Gabriel A., O’Malley, A. James, Moen, Erika L.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-07-2024; Springer Nature B.V
• Subjects: Adjuvant therapy; Aged; Aged, 80 and over; Breast cancer; Breast Neoplasms - surgery; Breast Neoplasms - therapy; Fee-for-Service Plans; Female; Follow-Up Studies; Global Health Services Research; Health Services Accessibility - statistics & numerical data; Humans; Mastectomy; Medical Oncology - statistics & numerical data; Medicare - statistics & numerical data; Medicine; Medicine & Public Health; Oncology; Patients; Prognosis; Rural Population - statistics & numerical data; Surgery; Surgical Oncology; Time-to-Treatment - statistics & numerical data; United States; United States; Treatment initiation; Breast cancer; Oncology outreach; Medicare; Fee-for-service
• ISSN: 1068-9265; 1534-4681; 1534-4681
• DOI: 10.1245/s10434-024-15195-y

Background
Oncology outreach is a common strategy for increasing rural access to cancer care, where traveling oncologists commute across healthcare settings to extend specialized care. Examining the extent to which physician outreach is associated with timely treatment for rural patients is critical for informing outreach strategies.
Methods
We identified a 100% fee-for-service sample of incident breast cancer patients from 2015 to 2020 Medicare claims and apportioned them into surgery and adjuvant therapy cohorts based on treatment history. We defined an outreach visit as the provision of care by a traveling oncologist at a clinic outside of their primary hospital service area. We used hierarchical logistic regression to examine the associations between patient receipt of preoperative care at an outreach visit (preoperative outreach) and > 60-day surgical delay, and patient receipt of postoperative care at an outreach visit (postoperative outreach) and > 60-day adjuvant delay.
Results
We identified 30,337 rural-residing patients who received breast cancer surgery, of whom 4071 (13.4%) experienced surgical delay. Among surgical patients, 14,501 received adjuvant therapy, of whom 2943 (20.3%) experienced adjuvant delay. In adjusted analysis, we found that patient receipt of preoperative outreach was associated with reduced odds of surgical delay (odds ratio [OR] 0.75, 95% confidence interval [CI] 0.61–0.91); however, we found no association between patient receipt of postoperative outreach and adjuvant delay (OR 1.04, 95% CI 0.85–1.25).
Conclusions
Our findings indicate that preoperative outreach is protective against surgical delay. The traveling oncologists who enable such outreach may play an integral role in catalyzing the coordination and timeliness of patient-centered care.