Highlights
- •We studied stage I and II breast cancer patients with breast conserving treatment.
- •We examined disparities in quality of radiation therapy duration.
- •There were no differences in average days of treatment across races.
- •Disparities do exist in frequency of failure to complete radiation in quality time.
- •Race, age, and insurance impact quality of completion of radiation therapy.
Abstract
Background
Radiotherapy completion (RTC) is critical to successful breast conserving treatment.
Our aim was to identify patient groups at greatest risk of not achieving timely radiotherapy
completion (TRTC) in an urban setting.
Methods
This observational cohort study used hospital registry data from 2004 to 2010 for
female stage I and II breast conserving treatment patients to assess predictors of
RTC and TRTC, defined as RTC of 35 to 49 days.
Results
Two hundred sixty-one patients were analyzed. There was no difference in mean days
to RTC by ethnicity (black 46.8, white 46.4, Hispanic 48.1 days, P = .75) or total RTC (black 88.2%, white 97.9%, Hispanic 93.3%, P = .09). However, a substantial difference was seen in TRTC by ethnicity (black 51.8%,
white 79.2%, Hispanic 57.8%, P = .03). Multivariate logistic regression analysis of failure to achieve TRTC found
associations with black race (odds ratio [OR] 2.67), Medicare (OR 3.46), Medicaid
(OR 2.19), and age less than 50 years (OR 4.13).
Conclusions
This study demonstrates high overall percentage RTC but demonstrates disparities in
TRTC. Those at greatest risk of unsuccessful TRTC were younger, Medicare or Medicaid
insured, and black race.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Howlader N. Noone A.M. Krapcho M. SEER Cancer Statistics Review, 1975-2010. National Cancer Institute, Bethesda, MD2013 (November 2012 SEER data submission ed)
- Cancer Facts & Figures 2012.American Cancer Society, Atlanta, GA2012 ([cited October 10, 2013])
- Breast Cancer Facts & Figures 2013-2014.American Cancer Society, Inc, Atlanta, GA2013
- Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer.N Engl J Med. 2002; 347: 1233-1241
- Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials.Lancet. 2011; 378: 1707-1716
- Disparities in the application of adjuvant radiotherapy after breast-conserving surgery for early stage breast cancer: impact on overall survival.Cancer. 2011; 117: 2590-2598
- Differences in the quality of breast cancer care among vulnerable populations.Cancer. 2005; 104: 2347-2358
- Patterns and correlates of adjuvant radiotherapy receipt after lumpectomy and after mastectomy for breast cancer.J Clin Oncol. 2010; 28: 2396-2403
- Compliance with breast-conservation standards for patients with early-stage breast carcinoma.Cancer. 2003; 97: 893-904
- The use of radiation as a component of breast conservation therapy in national comprehensive cancer network centers.J Clin Oncol. 2006; 24: 361-369
- Racial disparities in the use of radiotherapy after breast-conserving surgery: a national Medicare study.Cancer. 2010; 116: 734-741
- Surgeon characteristics and receipt of adjuvant radiotherapy in women with breast cancer.J Natl Cancer Inst. 2008; 100: 199-206
- Breast cancer trends of black women compared with white women.Arch Fam Med. 1999; 8: 521-528
- Racial variation in breast cancer treatment among department of defense beneficiaries.Cancer. 2012; 118: 812-820
- Trends in racial and age disparities in definitive local therapy of early-stage breast cancer.J Clin Oncol. 2009; 27: 713-719
- Does compliance with radiation therapy differ in African-American patients with early-stage breast cancer?.Breast J. 2010; 16: 193-196
- Missed opportunities: racial disparities in adjuvant breast cancer treatment.J Clin Oncol. 2006; 24: 1357-1362
- NCCN Clinical Practice Guidelines in Oncology: Breast Cancer. Version 1.2013 Ed.National Comprehensive Cancer Network; Ft. Washington, PA, 2013 ([cited October 10, 2013])
- The association of race/ethnicity, insurance status, and socioeconomic factors with breast cancer care.Cancer. 2011; 117: 180-189
- The effect of treatment interruptions in the postoperative irradiation of breast cancer.Oncology. 2005; 69: 214-223
- Long-term results of hypofractionated radiation therapy for breast cancer.N Engl J Med. 2010; 362: 513-520
- American college of radiology appropriateness criteria on conservative surgery and radiation: stages I and II breast carcinoma.J Am Coll Radiol. 2008; 5: 701-713
- Disparities in breast cancer treatment and outcomes: biological, social, and health system determinants and opportunities for research.Oncologist. 2013; 18: 986-993
- Racial disparities and trends in radiation therapy after breast-conserving surgery for early-stage breast cancer in women, 1992 to 2002.Ethn Dis. 2007; 17: 122-128
- Do young breast cancer patients have worse outcomes?.J Surg Res. 2003; 113: 109-113
- Long-term outcomes and clinicopathologic differences of African-American versus white patients treated with breast conservation therapy for early-stage breast cancer.Cancer. 2008; 113: 2565-2574
- Radiotherapy omission after breast-conserving surgery is associated with reduced breast cancer-specific survival in elderly women with breast cancer.Am J Surg. 2006; 191: 749-755
- Influence of race, insurance, socioeconomic status, and hospital type on receipt of guideline-concordant adjuvant systemic therapy for locoregional breast cancers.J Clin Oncol. 2012; 30: 142-150
- Insurance status and the use of guideline therapy in the treatment of selected cancers.J Clin Oncol. 2005; 23: 9079-9088
- Discontinuation of radiation treatment among Medicaid-enrolled women with local and regional stage breast cancer.Breast J. 2010; 16: 20-27
- Impact of patient distance to radiation therapy on mastectomy use in early-stage breast cancer patients.J Clin Oncol. 2005; 23: 7074-7080
- Wait times for surgical and adjuvant radiation treatment of breast cancer in Canada and the United States: greater socioeconomic inequity in America.Clin Invest Med. 2009; 32: E239-E249
Article Info
Publication History
Published online: July 30, 2015
Received in revised form:
April 1,
2015
Received:
September 26,
2014
Footnotes
There were no relevant financial relationships or any sources of support in the form of grants, equipment, or drugs.
The authors declare no conflicts of interest.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
