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

描述（由申请人提供）：低收入妇女省略乳房肿瘤切除术（BCS）放疗的结果背景：在美国，关于经济困难的乳腺癌妇女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）按服务收费的医疗补助索赔和1998年和1999年所有病例（N=1,402）的肿瘤登记数据连接起来，并证明了该数据集成策略在研究医疗补助中的辅助治疗（放疗和化疗）方面的高有效性。我们发现大约45%接受BCS的妇女在诊断之日起12个月内没有接受放疗。从社会安全死亡主档案获得的数据显示，在随后的中位72个月期间，未接受放疗的BCS妇女的死亡风险是接受放疗妇女的1.8倍，调整了合并症、分期和手术第一年的死亡。目的：提出了一个为期两年的项目，以确定在1997-2001年期间，在北卡罗来纳州接受按服务收费的医疗补助计划诊断为乳腺癌的妇女中，不接受放射治疗与较差的生存率之间的联系程度。具体来说，我们建议识别和分析：1)使用经过验证的算法使用索赔和注册数据识别和分析BCS的7年复发；2)病死率（所有癌症死亡，以及乳腺癌与所有其他原因的死亡），使用国家死亡指数增加系统；3)使用现有的医疗补助处方声明将激素治疗添加到数据集中，以描述获取途径，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：我们计划开发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在这一人群中癌症护理差异中的作用。

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.