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

低收入女性中省略肿瘤切除术 (BCS) 放射治疗的结果

• 批准号: 7086642
• 负责人: Roger T. Anderson
• 金额: $ 19.67万
• 依托单位: WAKE FOREST UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-04-10 至 2008-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7086642
• 关键词: Medicare /Medicaid; breast neoplasms; clinical research; comorbidity; death; low socioeconomic status; model; neoplasm /cancer

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.

描述（由申请人提供）：低收入女性中省略肿瘤切除术 (BCS) 放射治疗的结果 背景：描述美国患有乳腺癌的经济困难女性的医疗保健模式和结果的信息很少。在之前的工作中，我们开发并验证了一个集成数据库，该数据库将北卡罗来纳州 (NC) 按服务收费医疗补助索赔和 1998 年和 1999 年所有病例 (N=1,402) 的肿瘤登记数据联系起来，并记录了该数据集成策略在研究医疗补助辅助治疗（放射和化疗）方面的高度有效性。我们发现，大约 45% 接受 BCS 的女性在诊断之日起 12 个月内没有接受辐射。从社会保障死亡主档案中获得的数据显示，在调整手术第一年的合并症、分期和死亡后，患有 BCS 且未接受辐射的女性在随后的中位 72 个月期间的死亡风险是接受辐射的女性的 1.8 倍。目标：提议开展一个为期 2 年的项目，旨在确定北卡罗来纳州 1997 年至 2001 年接受按服务收费医疗补助计划并被诊断患有乳腺癌的妇女的生存率较差与遗漏辐射的关系程度。具体来说，我们建议识别和分析：1）使用索赔和注册数据以及经过验证的算法，BCS 的 7 年复发情况； 2) 使用国家死亡指数 Plus 系统计算病死率（所有癌症死亡、乳腺癌死亡与所有其他原因死亡）； 3) 使用现有的医疗补助处方声明将激素疗法添加到数据集中，以描述获取情况并作为复发和生存模型的预测因子。我们将使用回归和生存分析模型来比较 BCS（放射）的复发率和生存率，并调整年龄、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，以促进低收入妇女获得放射治疗，并调查卫生保健资源和基础设施对该人群癌症护理差异的作用。