Towards Comprehensive Care Throughout the Breast Cancer Care Trajectory in British Columbia, Canada Trajectory in British Columbia, Canada

Project number: 
15-021
Approval date: 
Friday, June 26, 2015
Principal Investigator: 
McBride,Mary
Institution: 
BC Cancer
Funding Agency: 
Canadian Institutes of Health Research(CIHR)
Datasets requested: 
PharmaNet
Citizenship and Immigration Canada (CIC) Permanent Residents
Home and Community Care (BC Ministry of Health)
Medical Services Plan (BC Ministry of Health)
Consolidation - demographic (Ministry of Health)
ACG Case Mix Group (Johns Hopkins University)
Mental Health (BC Ministry of Health)
Hospital Separations (BC Ministry of Health)
Consolidation registry (Ministry of Health)
bc cancer-external
Deaths (BC Vital Statistics Agency)
PharmaCare (BC Ministry of Health)
consolidation - census geocodes
Research objective: 

The overall purpose of the project is to answer the questions and objectives below that are part of an inter-disciplinary multi-jurisdictional coordinated program to enhance the capacity of community-based primary healthcare (CBPHC), to provide care to cancer patients and to improve the link between CBPHC and specialty care along the cancer care continuum.

Aims, objectives and hypothesis:
Aim A. Describe time to diagnosis and characteristics of pre-diagnosis care among women diagnosed with breast cancer in British Columbia (BC). Describe high users of care in this phase, and compare that to the population comparison group. Specifically, our objectives are:
1. To determine the time from first symptomatic physician encounter or screening test to confirmed diagnosis of in-situ or malignant breast cancer among women diagnosed in BC, and patient (e.g. age at diagnosis, immigrant status, socioeconomic status (SES), comorbidity prior to diagnosis), clinical (e.g. in-situ vs. invasive cancer, stage at diagnosis), and health system (e.g. previous mammography screening, region of service) characteristics leading to variation in time from first symptom to diagnosis;
Hypothesis: Breast cancer patients with longer time from first symptomatic physician encounter to confirmed diagnosis of malignant breast cancer in BC have greater health services use, in particular primary care visits and diagnostic tests and procedures, and present with later-stage disease at diagnosis; lower patient SES, higher comorbidity, and lower adherence to a primary care provider increase time to diagnosis. Compared to the general population, breast cancer patients receive more primary health care.

2. To examine characteristics of medical care use, in particular family physician/primary provider care (e.g. attachment and adherence to a primary care provider), and patient characteristics, in particular comorbidity, relating to high users of services, from first symptomatic physician encounter or screening test to confirmed diagnosis of in-situ or malignant breast cancer among women diagnosed in BC, adjusting for other patient, clinical, and health system characteristics;
Hypothesis: Breast cancer patients without attachment to or adherence to a primary care provider, and/or higher comorbidity, have higher levels of health services use during the pre-diagnosis period, after adjustment for other patient, clinical, and health system factors, due to lack of prompt and appropriate diagnostic investigation. Compared to the general population, the also have higher levels of health care utilization.

Aim B. Describe patterns and characteristics of oncology and family physician/primary provider care during initial cancer treatment of breast cancer patients in BC, including high users of care in this phase, and compare that to the general population. Specifically, our objectives are:
1. To determine the magnitude, patterns, and types of family physician/primary provider and oncology care during initial curative treatment, among women treated for breast cancer in BC, and patient (e.g. age at diagnosis, SES, immigrant status, urban/rural residence, comorbidity prior to diagnosis), disease (e.g. in-situ vs. invasive cancer, stage at diagnosis, treatment), other specialist care, and health system (e.g. region of service) characteristics affecting family physician/primary provider care;
Hypothesis: Breast cancer patients with presumed less accessibility to the health system (e.g. immigrants, those living in rural or Northern Health regions), and with less toxic treatments, receive less community-based primary health care (CBPHC) during treatment. Compared to the general population, breast cancer patients receive more CBPHC.
2. To identify the characteristics of medical care use, in particular family physician/primary provider care (e.g. attachment and adherence to a primary care provider), and patient characteristics, in particular comorbidity, relating to high users of services during initial curative treatment, adjusting for health system characteristics;
Hypothesis: Breast cancer patients without attachment to or adherence to a primary care provider, and/or higher comorbidity, have higher levels of health services use during the treatment period compared to those attached or adhere to a primary care provider, after adjustment for other patient, clinical, and health system factors, due to lack of prompt and appropriate management of cancer-related toxicities. Compared to the general population, they receive more CBPHC.

Aim C. Based on previous work that determined the extent and patterns of health services among women surviving a diagnosis of breast cancer in BC, describe quality of care and characteristics of high users of health services among BC breast cancer survivors post-treatment, until recurrence, new cancer, end-of-life care, or death; and compare that to the general population comparison group. Specifically, our objectives are:
1. To determine the level of compliance with follow-up care guidelines, (specifically annual physical exam, annual mammography, periodic bone densitometry for those on aromatase inhibitors, and absence of routine tumour marker tests), as specified by the BCCA Breast Cancer Tumour Group, among BC breast cancer survivors post-initial treatment, and patient (e.g. age at diagnosis, time since diagnosis, SES, immigrant status, urban/rural residence, comorbidity at diagnosis), disease (e.g. stage at diagnosis), and health system (e.g. region of service) characteristics leading to variation in follow-up care compliance.
Hypothesis: Breast cancer patients with presumed less accessibility to the health system (e.g. immigrants, those living in rural or Northern health regions) receive less guideline-based care during the post-treatment period; but more CBPHC compared to the general population.
2. To describe characteristics of medical care use, in particular family physician/primary provider care (e.g. attachment and adherence to a primary care provider), and patient characteristics, in particular comorbidity relating to high users of services, adjusting for health system characteristics;
Hypothesis: Breast cancer patients without attachment to or adherence to a primary care provider, and/or higher comorbidity, have higher levels of health services use during the post-treatment period, after adjustment for other patient, clinical, and health system factors, due to lack of prompt and appropriate management of cancer-related risks of recurrence, new cancers, late effects, and health promotion efforts. Compared to the general population, they also have higher levels of health care utilization.

Publications: 

Journal Publication


Page last revised: December 5, 2017