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

摘要 标题：低收入女性肿瘤切除术(BCS)后不接受放射治疗的结果 背景：很少有信息描述医疗保健的模式和财务状况 美国患有乳腺癌的贫困妇女。在以前的工作中，我们已经开发并验证了 将北卡罗来纳州(北卡罗来纳州)医疗补助服务费索赔和肿瘤登记数据链接起来的综合数据库 1998和1999年的所有案例(N=1,402)，并记录了该数据集成策略的高度有效性 研究医疗补助中的辅助治疗(放疗和化疗)。我们发现，大约45%的 接受BCS治疗的女性在确诊后12个月内没有接受放射治疗。获得的数据 从社会保障死亡总档案显示，患有BCS且未接受辐射的女性有1.8倍于 在随后的中位数72个月期间死亡的风险比那些接受辐射的人更高，调整后的因素 手术第一年的合并症、分期和死亡情况。 目标：建议一个为期两年的项目，以确定遗漏辐射与较差的联系的程度。 1997-2001年北方地区接受按服务收费的医疗补助被诊断为乳腺癌的妇女的存活率 卡罗莱纳。具体地说，我们建议识别和分析：1)使用索赔和 使用经过验证的算法的登记数据；2)病死率(所有癌症死亡和乳腺癌死亡与ALL 其他原因)使用国家死亡指数Plus系统；以及3)将激素疗法添加到数据集 使用现有的医疗补助处方来描述获得并作为复发和复发的预测因素 生存模式。我们将使用回归和生存分析模型来比较BCS(+/-辐射)的比率 根据年龄、合并症、肿瘤大小、分期、三苯氧胺处方状态、 荷尔蒙受体状态。 未来方向：我们计划制定社区和卫生系统干预措施，以促进获得 在低收入妇女中进行放射治疗，并调查卫生保健资源和 基础设施方面的癌症护理在这一人群中的差距。

ABSTRACT Title: 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.