Treatment of local breast carcinoma in Florida - The role of the distance to radiation therapy facilities
Treatment of local breast carcinoma in Florida - The role of the distance to radiation therapy facilities
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DOI：
10.1002/cncr.21557
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发表时间：
2006-01-01
期刊：
影响因子：
6.2
通讯作者：
Coebergh, JWW
中科院分区：
文献类型：
--
作者：
Voti, L;Richardson, LC;Coebergh, JWW
背景保乳手术联合放射治疗是局部乳腺癌的首选治疗方法。然而，有限的医疗服务可能导致更广泛的手术治疗。在佛罗里达州研究了距离放射治疗设施对接受BCSR可能性的影响。将1997年7月至2000年12月期间向佛罗里达州全州登记处报告的当地乳腺癌与卫生保健管理局住院和门诊数据库相关联，以补充登记处的治疗数据，导致18，903例接受BCSR或乳房切除术治疗的当地乳腺癌病例。接受BCSR的几率被建模为到最近的放射治疗机构的距离的函数，并根据健康保险、年龄、种族/民族和婚姻状况进行调整。距离最近的放射治疗设施与BCSR呈负相关，每增加5英里，比值比（OR）降低3%。与未投保的女性相比，私人保险女性接受BCSR的可能性高出49%（OR为1.49; 95%置信区间[95%CI]，1.20-1.86），医疗保险患者接受BCSR的可能性高出37%（OR为1.37; 95%CI，1.09-1.72）。诊断时的年龄呈负相关，年龄每增加一年，BCSR的几率降低1%。与非西班牙裔白色白人相比，西班牙裔女性接受BCSR的可能性低38%（OR为0.62; 95% CI，0.55-0.71）。已婚妇女接受BCSR的可能性比单身妇女高23%（OR为1.23; 95%CI，1.09-1.40）;分居、离婚或丧偶的妇女与单身妇女没有显著差异。放射治疗设施的距离可能会对佛罗里达BCSR的可能性产生负面影响。诊断时的年龄、保险类型、种族/民族和婚姻状况与BCSR相关。未来的努力应针对无保险，西班牙裔，老年人和未婚妇女，以减少差异的管理BCSR为当地乳腺癌。
BACKGROUND. Breast-conserving surgery combined with radiation (BCSR) is the recommended alternative treatment to mastectomy for local breast carcinoma. However, limited access to heallhcare may result in more extensive surgical treatment. The effect of distance to radiation therapy facilities on the likelihood of receiving BCSR was examined in Florida.METHODS. Local breast carcinomas reported to Florida's statewide registry between July, 1997, and December, 2000 were linked to the Agency of Healthcare Administration inpatient and outpatient databases to Supplement the registry's treatment data, resulting in 18,903 local breast carcinoma cases treated with BCSR or mastectomy. The odds of receiving BCSR were modeled as a function of distance to the closest radiation therapy facility, adjusting for health insurance, age, race/ ethnicity, and marital status.RESULTS. Distance to the closest radiation therapy facility was negatively associated with BCSR, with the odds ratio (OR) decreasing by 3% per 5-mile increase ill distance. Compared with the uninsured, privately insured women were 49% more likely to receive BCSR (OR of 1.49; 95% confidence interval [95% CI], 1.20-1.86) and Medicare patients were 37% more likely (OR of 1.37; 95% CI, 1.09-1.72). Age at diagnosis was negatively associated, reducing the odds of BCSR by 1% per year increase in age. Compared with white non-Hispanic, Hispanic women were 38% less likely to receive BCSR (OR of 0.62; 95% CI, 0.55-0.71). Married women were 23% more likely to receive BCSR compared with singles (OR of 1.23; 95% CI, 1.09-1.40); women who were separated, divorced, or widowed did not differ significantly from single women.CONCLUSIONS. Distance to radiation therapy facilities may negatively impact the likelihood of BCSR in Florida. Age at diagnosis, insurance type, race/ethnicity, and marital status were associated with BCSR. Future efforts should target the uninsured, Hispanics, the elderly, and the unmarried women to reduce disparities in the administration of BCSR for local breast carcinoma.