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Telephone-based intervention not associated with timely diagnostic resolution for breast cancer
Bastani R. Cancer Epidemiol Biomarkers Prev. 2010;19:1927–1936.
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A telephone-based intervention did not increase diagnostic resolution for breast cancer among low-income women, therefore researchers recommend more intensive interventions to achieve optimal diagnostic follow-up in this population.
“It is not easy to increase follow-up rates for abnormal breast findings among low-resource populations,” Roshan Bastani, PhD, School of Public Health, Division of Cancer Prevention and Control Research at the University of California, told HemOnc Today. “ A system level intervention may be needed, in addition to patient level interventions, in order to make a difference.”
Bastani and colleagues set out to assess the effect of a telephone-based intervention at increasing timely diagnostic resolution of abnormal breast findings in 1,708 women at two public hospitals with a breast abnormality.
Women were randomly assigned to either an intervention or control group. Primary outcome measure was timely diagnostic resolution within 6 months.
Compared with controls, no significant difference was observed for timely diagnostic resolution among women assigned to the telephone-based intervention (56% vs. 55%, respectively).
However, method of identification of an abnormality (OR=1.50) and location of first scheduled visit (OR=.62) were significant predictors for diagnostic resolution.
“We were surprised to find that the intervention was not effective in increasing follow-up,” Bastani said. “The patients that participated in the intervention reported it to be very helpful, but it still did not have an effect.”
The researchers suggest for future research to test patient and system-level interventions beyond the current study period.
Resolution of health disparities in breast screening and evaluation could further decrease the death rate from this disease. In this study, the authors randomized women with an abnormal breast finding (lump or mammogram) to a telephone intervention or usual care. Unfortunately, the intervention did not improve the primary endpoint — timely diagnostic resolution. In the authors' care system (Los Angeles County Department of Health Services), women were assigned a first appointment date. Interestingly, if women could attend their first scheduled appointment, then 66% had timely resolution of the finding. If they could not attend, then none of the woman had timely resolution. This assignment of a first appointment date differs from better resourced systems where direct communication with the patient (not unlike the intervention studied) allows women to schedule their most convenient appointment time. As the authors note "system-level factors at both hospitals may have been the causal agents" for the failure of the intervention in this poor population of women. It is clear that system wide interventions are necessary to close disparity gaps.
– Doug Yee, MD
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