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Article

Primary Care Continuity and Wait Times to Receiving Breast Cancer Chemotherapy: A Population-Based Retrospective Cohort Study Using CanIMPACT Data

1
Department of Family & Community Medicine, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
2
Department of Family & Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
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Department of Family & Community Medicine, Women’s College Hospital, Toronto, ON M5S 1B2, Canada
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Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
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Institute for Clinical Evaluative Sciences (ICES), Toronto, ON M4N 3M5, Canada
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Princess Margaret Cancer Centre, Department of Medical Oncology & Hematology, University Health Network, Toronto, ON M5G 2C1, Canada
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Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
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Ontario Institute for Cancer Research, Toronto, ON M5G 0A3, Canada
*
Author to whom correspondence should be addressed.
Curr. Oncol. 2021, 28(6), 4786-4804; https://doi.org/10.3390/curroncol28060405
Received: 8 September 2021 / Revised: 2 November 2021 / Accepted: 7 November 2021 / Published: 17 November 2021
(1) Background: Wait times to chemotherapy are associated with morbidity and mortality in breast cancer patients; however, it is unclear how primary care physician (PCP) continuity impacts these wait times, or whether this association is different in immigrants, who experience cancer care inequities. We assessed the association between PCP continuity and the contact-to-chemotherapy interval (wait time from when a patient first presents to healthcare to the first day of receiving breast cancer chemotherapy), with a specific look at the immigrant population. (2) Methods: Population-based, retrospective cohort study of women who were diagnosed with stage I–III breast cancer in Ontario who received surgery and adjuvant chemotherapy. We used quantile regression at the median and 90th percentile to quantify the effect of PCP continuity on the contact-to-chemotherapy interval, performing a separate analysis on the immigrant population. (3) Results: Among 12,781 breast cancer patients, including 1706 immigrants, the median contact-to-chemotherapy interval (126 days) was 3.21 days shorter (95% confidence interval (CI) 0.47–5.96) in symptom-detected patients with low PCP continuity, 10.68 days shorter (95% CI 5.36–16.00) in symptom-detected patients with no baseline PCP visits and 17.43 days longer (95% CI 0.90–34.76) in screen-detected immigrants with low PCP continuity compared to the same groups with high PCP continuity. (4) Conclusions: Higher PCP continuity was not associated with a change in the contact-to-chemotherapy interval for most of our study population, but was associated with a marginally longer interval in our symptom-detected population and a shorter contact-to-chemotherapy interval in screen-detected immigrants. This highlights the importance of PCP continuity among immigrants with positive screening results. Additionally, having no PCP visits at baseline was associated with a shorter contact-to-chemotherapy interval in symptom-detected patients. View Full-Text
Keywords: breast cancer; primary health care; population health; wait times breast cancer; primary health care; population health; wait times
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MDPI and ACS Style

Walsh, R.L.; Lofters, A.; Moineddin, R.; Krzyzanowska, M.; Grunfeld, E. Primary Care Continuity and Wait Times to Receiving Breast Cancer Chemotherapy: A Population-Based Retrospective Cohort Study Using CanIMPACT Data. Curr. Oncol. 2021, 28, 4786-4804. https://doi.org/10.3390/curroncol28060405

AMA Style

Walsh RL, Lofters A, Moineddin R, Krzyzanowska M, Grunfeld E. Primary Care Continuity and Wait Times to Receiving Breast Cancer Chemotherapy: A Population-Based Retrospective Cohort Study Using CanIMPACT Data. Current Oncology. 2021; 28(6):4786-4804. https://doi.org/10.3390/curroncol28060405

Chicago/Turabian Style

Walsh, Rachel L., Aisha Lofters, Rahim Moineddin, Monika Krzyzanowska, and Eva Grunfeld. 2021. "Primary Care Continuity and Wait Times to Receiving Breast Cancer Chemotherapy: A Population-Based Retrospective Cohort Study Using CanIMPACT Data" Current Oncology 28, no. 6: 4786-4804. https://doi.org/10.3390/curroncol28060405

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