TY - JOUR
T1 - Underuse of radiation therapy after breast conservation surgery in Puerto Rico
T2 - A puerto rico central cancer registry-health insurance linkage database study
AU - Chance, William W.
AU - Ortiz-Ortiz, Karen J.
AU - Liao, Kai Ping
AU - Zegarra, Diego E.Zavala
AU - Stauder, Michael C.
AU - Giordano, Sharon H.
AU - Tortolero-Luna, Guillermo
AU - Ashleigh Guadagnolo, B.
N1 - Publisher Copyright:
© 2017 by American Society of Clinical Oncology.
PY - 2018
Y1 - 2018
N2 - Purpose To identify rates of postoperative radiation therapy (RT) after breast conservation surgery (BCS) in women with stage I or II invasive breast cancer treated in Puerto Rico and to examine the sociodemographic and health services characteristics associated with variations in receipt of RT. Methods The Puerto Rico Central Cancer Registry-Health Insurance Linkage Database was used to identify patients diagnosed with invasive breast cancer between 2008 and 2012 in Puerto Rico. Claims codes identified the type of surgery and the use of RT. Logistic regression models were used to examine the independent association between sociodemographic and clinical covariates. Results Among women who received BCS as their primary definitive treatment, 64% received adjuvant RT. Significant predictors of RT after BCS included enrollment in Medicare (odds ratio [OR], 2.14; 95% CI, 1.46 to 3.13; P ≤.01) and dual eligibility for Medicare and Medicaid (OR, 1.61; 95% CI, 1.14 to 2.27; P <.01). In addition, it was found that RT was more likely to have been received in certain geographic locations, including the Metro-North (OR, 2.20; 95% CI, 1.48 to 3.28; P <.01), North (OR, 1.78; 95% CI, 1.20 to 2.64; P <.01), West (OR, 4.04; 95% CI, 2.61 to 6.25; P <.01), and Southwest (OR, 2.79; 95% CI, 1.70 to 4.59; P <.01). Furthermore, patients with tumor size > 2.0 cm and ≤ 5.0 cm (OR, 0.61; 95% CI, 0.40 to 0.93; P =.02) and those with tumor size > 5.0 cm (OR, 0.37; 95% CI, 0.15 to 0.92; P =.03) were found to be significantly less likely to receive RT. Conclusion Underuse of RT after BCS was identified in Puerto Rico. Patients enrolled in Medicare and those who were dually eligible for Medicaid and Medicare were more likely to receive RT after BCS compared with patients withMedicaid alone. There were geographic variations in the receipt of RT on the island.
AB - Purpose To identify rates of postoperative radiation therapy (RT) after breast conservation surgery (BCS) in women with stage I or II invasive breast cancer treated in Puerto Rico and to examine the sociodemographic and health services characteristics associated with variations in receipt of RT. Methods The Puerto Rico Central Cancer Registry-Health Insurance Linkage Database was used to identify patients diagnosed with invasive breast cancer between 2008 and 2012 in Puerto Rico. Claims codes identified the type of surgery and the use of RT. Logistic regression models were used to examine the independent association between sociodemographic and clinical covariates. Results Among women who received BCS as their primary definitive treatment, 64% received adjuvant RT. Significant predictors of RT after BCS included enrollment in Medicare (odds ratio [OR], 2.14; 95% CI, 1.46 to 3.13; P ≤.01) and dual eligibility for Medicare and Medicaid (OR, 1.61; 95% CI, 1.14 to 2.27; P <.01). In addition, it was found that RT was more likely to have been received in certain geographic locations, including the Metro-North (OR, 2.20; 95% CI, 1.48 to 3.28; P <.01), North (OR, 1.78; 95% CI, 1.20 to 2.64; P <.01), West (OR, 4.04; 95% CI, 2.61 to 6.25; P <.01), and Southwest (OR, 2.79; 95% CI, 1.70 to 4.59; P <.01). Furthermore, patients with tumor size > 2.0 cm and ≤ 5.0 cm (OR, 0.61; 95% CI, 0.40 to 0.93; P =.02) and those with tumor size > 5.0 cm (OR, 0.37; 95% CI, 0.15 to 0.92; P =.03) were found to be significantly less likely to receive RT. Conclusion Underuse of RT after BCS was identified in Puerto Rico. Patients enrolled in Medicare and those who were dually eligible for Medicaid and Medicare were more likely to receive RT after BCS compared with patients withMedicaid alone. There were geographic variations in the receipt of RT on the island.
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U2 - 10.1200/JGO.2016.008664
DO - 10.1200/JGO.2016.008664
M3 - Article
C2 - 30241162
AN - SCOPUS:85063465217
SN - 2378-9506
VL - 2018
SP - 1
EP - 9
JO - Journal of Global Oncology
JF - Journal of Global Oncology
IS - 4
ER -