Associations of surgical breast cancer treatment at regional or community hospitals with patient-reported experience measures

PURPOSE: High-volume hospitals deliver improved outcomes for patients with breast cancer, supporting referrals for breast cancer surgical care to high-volume regional facilities. This retrospective cohort study investigated how multidisciplinary cancer care trajectories and patient care experiences varied by surgical facility classification (regional vs. community as a proxy for high- vs. low-volume) and whether effects differed by rural-residence. METHODS: We used Surveillance, Epidemiology, and End Results-Consumer Assessment of Healthcare Providers and Systems (SEER-CAHPS) data for Medicare beneficiaries who received surgery for non-metastatic breast cancer from 2009 to 2019. We mapped cancer care trajectories using facility classification and oncologist specialty and performed state sequence analysis to identify care trajectory clusters. We used linear mixed-effects models to examine associations of surgical facility classification with patient-reported experience measures and assessed effect modification by rurality. RESULTS: Of the 3,327 patients in our cohort, 15.4% were rural-residing and 68.8% received surgery at a regional facility. Care trajectories indicated that patients tended to receive adjuvant care from the same type of facility as their surgical treatment. Patients who received surgery at community facilities (vs. regional) were significantly more likely to report better experiences with getting needed care (Est. (95%CI) = 3.5 (0.10,6.9), p = 0.043), with no significant differences for getting care quickly, care coordination, or doctor communication. Rural-residence was not a significant effect modifier. CONCLUSION: Receiving surgery at community facilities is associated with better patient-reported experiences for getting needed care. Moreover, surgical facility classification appears to influence the setting for subsequent cancer care, which may impact patient experiences in getting needed care. CLINICAL TRIAL NUMBER: Not applicable.