Outcomes of Omission of Radiation With Lumpectomy (BCS) Among Low-Income Women

描述（由申请人提供）：低收入妇女中放射治疗与肿块切除术（BCS）的结果背景：在美国，几乎没有描述经济上有需要的乳腺癌妇女的医疗保健模式和结果的信息。在以前的工作中，我们已经开发并验证了一个综合数据库，该数据库将1998年和1999年（N= 1，402）所有病例的北卡罗来纳州（NC）按服务付费医疗补助索赔和肿瘤登记数据联系起来，并记录了该数据整合策略在研究医疗补助辅助治疗（放疗和化疗）方面的高有效性。我们发现，大约45%接受BCS的女性在诊断后12个月内没有接受放射治疗。从社会保障死亡主文件中获得的数据显示，患有BCS且未接受辐射的女性在随后的中位数72个月期间的死亡风险是接受辐射的女性的1.8倍，并对合并症，阶段和手术第一年的死亡进行了调整。目的：提出了一个为期2年的项目，以确定在北卡罗来纳州1997-2001年诊断为乳腺癌的有偿服务医疗补助妇女中，放射治疗的遗漏与生存率降低的程度。具体而言，我们建议识别和分析：1）使用索赔和注册数据以及经验证的算法的BCS 7年复发率; 2）病例死亡率（所有癌症死亡，乳腺癌死亡与所有其他原因）使用国家死亡指数+系统;和3）使用现有的医疗补助处方索赔将激素治疗添加到数据集中，以描述访问并作为复发和生存的预测因素模型我们将使用回归和生存分析模型来比较BCS（放疗）的复发率和生存率，调整年龄，合并症，肿瘤大小，分期，他莫昔芬处方状态，激素受体状态。未来方向：我们计划制定社区和卫生系统干预措施，以促进低收入妇女接受放射治疗，并调查卫生保健资源和基础设施对这一人群癌症护理差异的作用。

DESCRIPTION (provided by applicant): Outcomes of Omission of Radiation With Lumpectomy (BCS) Among Low-Income Women Background: There is little information describing the patterns of health care and outcomes in financially needy women with breast cancer in the United States. In previous work we have developed and validated an integrated database linking North Carolina (NC) fee-for-service Medicaid claims and tumor registry data for all cases in 1998 and 1999 (N=1,402) and documented the high validity of this data integration strategy to study adjuvant treatment (radiation and chemotherapy) in Medicaid. We find that approximately 45% of women who received BCS did not receive radiation within 12 months from date of diagnosis. Data obtained from the Social Security Death Master File showed that women with BCS and no radiation have 1.8 times the risk of dying during the subsequent median 72 month period than those who were radiated, adjusting for comorbidity, stage, and deaths in first year of surgery. Objectives: Proposed is a 2-year project to ascertain the extent that omission of radiation is linked to poorer survival in women with fee-for-service Medicaid diagnosed with breast cancer in years 1997-2001 in North Carolina. Specifically, we propose to identify and analyze: 1) 7-year recurrence with BCS using claims and registry data with a validated algorithms; 2) case-fatality (all cancer deaths, and breast cancer deaths vs all other causes) using the National Death Index Plus system; and 3) to add hormonal therapy to the dataset using existing Medicaid prescription claims to describe access and as a predictor in the recurrence and survival models. We will use regression and survival analytic models to compare rates of BCS ( radiation) on recurrence and survival, adjusting for age, comorbidity, tumor size, stage, tamoxifen prescription status, hormone receptor status. Future Directions: We plan to develop community and health systems interventions to promote access to radiotherapy among low income women, and investigate the role of health care resources and Infrastructure on cancer care disparities in this population.