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Survival disadvantage among Medicaid-insured breast cancer patients treated with breast conserving surgery without radiation therapy.

Publication ,  Journal Article
Foley, KL; Kimmick, G; Camacho, F; Levine, EA; Balkrishnan, R; Anderson, R
Published in: Breast Cancer Res Treat
January 2007

BACKGROUND: Clinical studies indicate that breast cancer patients treated with breast conserving surgery (BCS) without radiotherapy (RT) have a greater risk of recurrence and mortality compared to those receiving BCS plus RT. However, this relationship has been underdeveloped among low-income women in the community who may face barriers in accessing adjuvant treatment and post-treatment surveillance. It is possible that the prognostic significance of omission of RT in clinical trials underestimates the significance of risk in the community. METHODS: Using cancer registry, Medicaid claims, and the Social Security Master Death File, we evaluated receipt of RT in women with early stage breast cancer treated with BCS and mean 6-year overall and cancer-specific survival. Logistic regression was used to assess correlates of RT. The Kaplan-Meier method was used to determine survival by RT status and a multivariate Cox proportional hazards regression was used to evaluate the role of RT status on overall and cause-specific survival. RESULTS: A total of 65% of women received RT, and 82% of the sample survived the study period. Death rates of 16% and 51% were observed among those who did and did not receive RT, respectively (P < 0.001). One-third of women who died from cancer (8 of 24) received radiation. Use of RT was associated with a statistically significant decrease in all-cause (hazard ratio = 0.42, 95% CI 0.21-0.85) and cancer-specific mortality (hazard ratio = 0.22, 95% CI -0.09 to 0.57). CONCLUSIONS: Adjuvant radiation following BCS was underused in this sample of poor breast cancer patients. Lack of adjuvant RT may be a proxy for inadequate access to care and poor cancer surveillance after treatment.

Duke Scholars

Published In

Breast Cancer Res Treat

DOI

ISSN

0167-6806

Publication Date

January 2007

Volume

101

Issue

2

Start / End Page

207 / 214

Location

Netherlands

Related Subject Headings

  • Survival Analysis
  • Radiotherapy, Adjuvant
  • Poverty
  • Oncology & Carcinogenesis
  • Middle Aged
  • Medicaid
  • Mastectomy, Segmental
  • Humans
  • Female
  • Combined Modality Therapy
 

Citation

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MLA
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Foley, K. L., Kimmick, G., Camacho, F., Levine, E. A., Balkrishnan, R., & Anderson, R. (2007). Survival disadvantage among Medicaid-insured breast cancer patients treated with breast conserving surgery without radiation therapy. Breast Cancer Res Treat, 101(2), 207–214. https://doi.org/10.1007/s10549-006-9280-2
Foley, Kristie Long, Gretchen Kimmick, Fabian Camacho, Edward A. Levine, Rajesh Balkrishnan, and Roger Anderson. “Survival disadvantage among Medicaid-insured breast cancer patients treated with breast conserving surgery without radiation therapy.Breast Cancer Res Treat 101, no. 2 (January 2007): 207–14. https://doi.org/10.1007/s10549-006-9280-2.
Foley KL, Kimmick G, Camacho F, Levine EA, Balkrishnan R, Anderson R. Survival disadvantage among Medicaid-insured breast cancer patients treated with breast conserving surgery without radiation therapy. Breast Cancer Res Treat. 2007 Jan;101(2):207–14.
Foley, Kristie Long, et al. “Survival disadvantage among Medicaid-insured breast cancer patients treated with breast conserving surgery without radiation therapy.Breast Cancer Res Treat, vol. 101, no. 2, Jan. 2007, pp. 207–14. Pubmed, doi:10.1007/s10549-006-9280-2.
Foley KL, Kimmick G, Camacho F, Levine EA, Balkrishnan R, Anderson R. Survival disadvantage among Medicaid-insured breast cancer patients treated with breast conserving surgery without radiation therapy. Breast Cancer Res Treat. 2007 Jan;101(2):207–214.
Journal cover image

Published In

Breast Cancer Res Treat

DOI

ISSN

0167-6806

Publication Date

January 2007

Volume

101

Issue

2

Start / End Page

207 / 214

Location

Netherlands

Related Subject Headings

  • Survival Analysis
  • Radiotherapy, Adjuvant
  • Poverty
  • Oncology & Carcinogenesis
  • Middle Aged
  • Medicaid
  • Mastectomy, Segmental
  • Humans
  • Female
  • Combined Modality Therapy