The involvement of patients as partners in making decisions about their medical treatments is an important aspect of patient-centered care. A recent study from England examined the decisions breast cancer patients make when considering where to undergo their treatment, evaluating the potential impact of policies offering such choices on healthcare inequalities. The findings were published online by Wiley in CANCER, a peer-reviewed journal of the American Cancer Society.
For the study, researchers analyzed data from the National Health Service (NHS), the publicly funded healthcare system in the UK, which allows cancer patients to choose any hospital that offers cancer treatments. They identified all women diagnosed with breast cancer from 2016 to 2018 who underwent either a breast-conserving operation or a mastectomy.
Records showed that 22,622 out of 69,153 patients who underwent breast-conserving surgery (32.7%) and 7,179 out of 23,536 patients who underwent a mastectomy (30.5%) bypassed their nearest hospital to get operated further away from home. Younger women, those without comorbidities, of white ethnicity, or living in rural areas were more likely to travel to hospitals further away.
Patients were more likely to be treated in hospitals classified as specialized breast reconstruction centers, even if they did not undergo breast reconstruction surgery after the operation. Those who had a mastectomy and immediate breast reconstruction were more likely to travel to hospitals where surgeons had a good reputation for breast cancer operations, and less likely to travel to hospitals with shorter surgical waiting times. The patients did not base their decisions on hospital research activities, quality ratings, frequency of breast reoperations (to remove additional cancer cells), or status as a multidisciplinary cancer center (where patients can receive all their care at one location).
The researchers found that this segregation—older patients, those with comorbidities, and those from ethnic minority backgrounds being treated in their local hospital while others travel to different hospitals and specialized centers—could further exacerbate inequalities in access to high-quality care.
As marginalized groups already face barriers to access high-quality care, it is important for policymakers to consider measures that mitigate the risks of increasing disparities in access and outcomes, by providing, for example, free transportation, accommodation, or even protection against income loss. Additionally, patients prefer information about the quality of breast cancer care in hospitals in their region at the beginning of the treatment pathway when they receive a diagnosis. Such information should be presented in a format that can support the trade-offs patients need to make.
Lu Han, PhD, Co-author, London School of Hygiene & Tropical Medicine
Aggarwal, A., et al. (2023) Association of travel time, patient characteristics, and hospital quality with patient mobility for breast cancer surgeries: A national population-based study. CANCER. doi.org/10.1002/cncr.35153.