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. 2021 Nov 17;28(6):4786-4804.
doi: 10.3390/curroncol28060405.

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

Rachel Lin Walsh  1   2 , Aisha Lofters  2   3   4   5 , Rahim Moineddin  2   4   5 , Monika Krzyzanowska  6   7 , Eva Grunfeld  2   8
Affiliations

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

Rachel Lin Walsh et al. Curr Oncol. .

Abstract

(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.

Keywords: breast cancer; population health; primary health care; wait times.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Boxplots of all intervals in days separated by the method of breast cancer detection. Note: Surgery-to-chemotherapy interval not separated by detection method since breast cancer detection is not relevant during this interval.
Figure 2
Figure 2
Adjusted median and 90th percentile (a) contact-to-chemotherapy, (b) primary care and (c) surgery-to-chemotherapy intervals in days by continuity of primary care at baseline separated by method of breast cancer detection, where applicable, with 95% confidence intervals in the entire cohort. PCP—primary care provider; low continuity—usual provider of care (UPC) index ≤ 0.75; high continuity—UPC index > 0.75. * indicates statistical significance.
Figure 2
Figure 2
Adjusted median and 90th percentile (a) contact-to-chemotherapy, (b) primary care and (c) surgery-to-chemotherapy intervals in days by continuity of primary care at baseline separated by method of breast cancer detection, where applicable, with 95% confidence intervals in the entire cohort. PCP—primary care provider; low continuity—usual provider of care (UPC) index ≤ 0.75; high continuity—UPC index > 0.75. * indicates statistical significance.
Figure 3
Figure 3
Adjusted median and 90th percentile (a) contact-to-chemotherapy, (b) primary care and (c) surgery-to–chemotherapy intervals in days by continuity of primary care at baseline separated by method of breast cancer detection, where applicable, with 95% confidence intervals (CIs) in the immigrant-only population. PCP—primary care provider; low continuity—usual provider of care (UPC) index ≤ 0.75; high continuity—UPC index > 0.75. * indicates statistical significance. Only the upper portion of the 95% CI is shown for 90th percentile intervals for clarity.
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