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Vol. 38. Issue 4.
Pages 224-232 (July - August 2023)
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Vol. 38. Issue 4.
Pages 224-232 (July - August 2023)
Original Article
Factors from healthcare delivery affecting breast cancer survival in a health area of Northern of Spain
Factores de la asistencia sanitaria que afectan a la supervivencia del cáncer de mama en un área del norte de España
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N. Robles-Rodrígueza, A. Llaneza-Folguerasb, A. Lanaa,c,
Corresponding author
lanaalberto@uniovi.es

Corresponding author.
a Department of Medicine, School of Medicine and Health Sciences, University of Oviedo, Oviedo, Asturias, Spain
b Breast Pathology Unit, Central University Hospital of Asturias, Health Care Service of Asturias, Spain
c Institute of Sanitary Research of Asturias (ISPA), Oviedo, Asturias, Spain
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Tables (3)
Table 1. Characteristics of BC patients from a population-based cancer registry, Asturias-Spain, according to demographic, clinical and health care delivery variables.
Table 2. Statistics of BC patients for censored and death group.
Table 3. Variables associated with all-cause of death of BC patients from multivariate Cox proportional hazard model.
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Abstract
Objective

Clinical breast cancer decision-making significantly affects life expectancy and management of hospital resources. The aims of the present study were to estimate the time of survival for breast cancer patients and to identify independent factors from healthcare delivery associated with survival rates in a specific health area of Northern of Spain.

Methods

Survival analysis was conducted among a cohort of 2545 patients diagnosed with breast cancer between 2006 and 2012 from the population breast cancer registry of Asturias-Spain and followed up till 2019. Adjusted Cox proportional hazard models were used to identify the independent prognostic factors of all-cause from death.

Results

The 5-year survival rate was 80%. Advanced age (>80 years) (hazard ratio, HR: 4.35; 95% confidence interval, CI: 3.41–5.54), hospitalization in small hospitals (HR: 1.46; 95% CI: 1.09–1.97), treatment in oncology wards (HR: 3.57; 95% CI: 2.41–5.27), and length of stay >30 days (HR: 2.24; 95% CI: 1.32–3.79) were the main predictors of death. By contrast, breast cancer suspected via screening was associated with a lower risk of death (HR: 0.55; 95% CI: 0.35–0.87).

Conclusion

There is room for improvement in survival rates after breast cancer in the health area of Asturias (Northern of Spain). Some healthcare delivery factors, and other clinical characteristics of the tumor influence the survival of breast cancer patients. Strengthening population screening programs could be relevant to increasing survival rates.

Keywords:
Breast cancer
Cox proportional hazard model
Delivery of health care
Survival analyses
Follow-up studies
Resumen
Objetivo

La toma de decisiones clínicas en el cáncer de mama afecta significativamente a la esperanza de vida y a la gestión de los recursos hospitalarios. Los objetivos fueron estimar el tiempo de supervivencia de las pacientes con cáncer de mama e identificar factores independientes de la asistencia sanitaria asociados a la tasa de supervivencia en el área de Asturias (norte de España).

Métodos

Se realizó un análisis de supervivencia en una cohorte de 2.545 pacientes diagnosticadas de cáncer de mama entre 2006 y 2012, procedentes del registro poblacional de cáncer de mama de Asturias-España y seguidas hasta 2019. Se utilizaron modelos de riesgos proporcionales de Cox ajustados para identificar los factores pronósticos independientes de muerte por cualquier causa.

Resultados

La tasa de supervivencia a los cinco años fue de 80%. La edad avanzada (>80 años) (hazard ratio [HR]: 4,35; intervalo de confianza [IC] 95%: 3,41-5,54), la hospitalización en hospitales pequeños (HR: 1,46; IC 95%: 1,09-1,97), el tratamiento en el servicio de oncología (HR: 3,57; IC 95%: 2,41-5,27) y la duración de la estancia >30 días (HR: 2,24; IC 95%: 1,32-3,79) fueron los principales predictores de muerte. Por el contrario, la sospecha de cáncer de mama mediante el programa de cribado poblacional se asoció a un menor riesgo de muerte (HR: 0,55; IC 95%: 0,35-0,87).

Conclusiones

Existe margen de mejora en las tasas de supervivencia tras cáncer de mama en Asturias-España. Algunos factores asistenciales y otras características clínicas del tumor influyen en la supervivencia de las pacientes con cáncer de mama. Reforzar los programas de cribado poblacional podría ser relevante para aumentar las tasas de supervivencia.

Palabras clave:
Cáncer de mama
Modelo de riesgos proporcionales de Cox
Asistencia sanitaria
Análisis de supervivencia
Estudios de seguimiento

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