Early Stage Breast Cancer Treatments for Younger Medicare Beneficiaries with Different Disabilities

Iezzoni, Lisa I.; Ngo, Long; Li, Donglin; Roetzheim, Richard G.; Drews, Reed E.; McCarthy, Ellen P.

doi:10.1111/j.1475-6773.2008.00853.x

Cited by 33 publications

(18 citation statements)

References 32 publications

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“…Other studies have also reported lower rates of recommended care for younger Medicare beneficiaries (who qualify for coverage because of disability or end-stage renal disease). 23,24 Comorbid illness and poor tolerance of therapy may contribute to these differences. A recent study examined care for more than 3000 women insured by a Southeastern US health plan and observed that black women had lower rates of hormonal therapy than white women despite uniform insurance coverage.…”

Section: Discussionmentioning

confidence: 99%

The association of race/ethnicity, insurance status, and socioeconomic factors with breast cancer care

Freedman

Virgo

et al. 2010

Cancer

183

146

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BACKGROUND: Few data are available on how race/ethnicity, insurance, and socioeconomic status (SES) interrelate to influence breast cancer treatment. The authors examined care for a national cohort of breast cancer patients to assess whether insurance and SES were associated with racial/ethnic differences in care. METHODS: The authors used multivariate logistic regression to assess the probability of definitive locoregional therapy, hormone receptor testing, and adjuvant systemic therapy among 662,117 white, black, and Hispanic women diagnosed with invasive breast cancer during 1998-2005 at National Cancer Data Base hospitals. In additional models, the authors included insurance and area-level SES to determine whether these variables were associated with observed racial/ethnic disparities. RESULTS: Most women were white (86%), 10% were black, and 4% were Hispanic. Most had private insurance (51%) or Medicare (41%). Among eligible patients, 80.0% (stage I/II) had definitive locoregional therapy, 98.5% (stage I-IV) had hormone receptor testing, and 53.1% and 50.2% (stage I-III) received adjuvant hormonal therapy and chemotherapy, respectively. After adjustment, black (vs white) women had less definitive locoregional therapy (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.88-0.94), hormonal therapy (OR, 0.90; 95% CI, 0.87-0.93), and chemotherapy (OR, 0.87; 95% CI, 0.84-0.91). Hispanic (vs white) women were also less likely to receive hormonal therapy. Hormone receptor testing did not differ by race/ethnicity. Racial disparities persisted despite adjusting for insurance and SES. CONCLUSIONS: The modest association between black (vs white) race and guideline-recommended breast cancer care was insensitive to adjustment for insurance and area-level SES. Further study is required to better understand disparities and to ensure receipt of care. Cancer 2011;117:180-9.

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Section: Discussionmentioning

confidence: 99%

The association of race/ethnicity, insurance status, and socioeconomic factors with breast cancer care

Freedman

Virgo

et al. 2010

Cancer

183

146

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“…Patients who were diagnosed at autopsy, had metastatic disease at diagnosis (including spread to distant sites within the central nervous system), were diagnosed with another malignancy prior to developing a primary brain tumor, or who had clinical information that was not complete were excluded, leaving 19,565 patients eligible for analysis. Patients were considered to have received adjuvant radiotherapy if radiation was administered within four and twelve months of diagnosis for patients diagnosed up to and after 1998, respectively, per coding guidelines established by SEER [20].…”

Section: Patient Populationmentioning

confidence: 99%

Radiotherapy and death from cerebrovascular disease in patients with primary brain tumors

Aizer

Wen

et al. 2015

J Neurooncol

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Radiotherapy is often used in the management of primary brain tumors, but late cerebrovascular risks remain incompletely characterized. We examined the relationship between radiotherapy and the risk of death from cerebrovascular disease (CVD) in this population. We used the Surveillance, Epidemiology, and End Results Program to identify 19,565 patients of any age diagnosed with a primary brain tumor between 1983-2002. Multivariable competing risks analysis and an interaction model were used to determine whether receipt of radiotherapy was associated with an increased risk of CVD-specific death, adjusting for tumor proximity to central arterial circulations of the brain. The median follow up in surviving patients was 12.75 years. Baseline characteristics were similar in patients who did and did not receive radiotherapy. Ten-year CVD-specific mortality in patients with tumors near central arterial circulations who did and did not receive radiotherapy were 0.64 % (95 % CI 0.42-0.93 %) versus 0.16 % (95 % CI 0.055-0.40 %), p = 0.01. After adjustment for demographic, tumor-related, and treatment-related covariates, patients with tumors near central arterial circulations were significantly more likely to experience CVD-specific mortality after radiotherapy (HR 2.81; 95 % CI 1.25-6.31; p = 0.01); no association was observed among patients with more distant tumors (HR 0.77; 95 % CI 0.50-1.16; p = 0.21). The interaction model showed that tumor location was a key predictor of the risk of radiotherapy-associated, CVD-specific mortality (p-interaction = 0.004). Patients receiving radiotherapy for tumors near but not distant from the central vasculature of the brain are at increased risk for death secondary to CVD, which should be considered when counseling patients.

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“…In particular, they are less likely to obtain screening mammography than are other women (Chan et al, 1999; Chevarley, Thierry, Gill, Ryerson, & Nosek, 2006; Iezzoni, McCarthy, Davis, & Siebens, 2000; Iezzoni, McCarthy, Davis, Harris-David, & O'Day, 2001; Iezzoni, 2008; Nosek & Howland, 1997; Wei, Findley, & Sambamoorthi, 2006). Women with disabilities who develop breast cancer may have lower rates of breast conserving surgery (BCS); even if they do undergo BCS, they may receive radiation therapy less often (Iezzoni et al, 2008; McCarthy, Ngo, Roetzheim, Chirikos, Li, Drews, & Iezzoni, 2006b). Women with disabilities are more likely to die from their breast cancers than are other women(Iezzoni et al, 2008; McCarthy, Ngo, Roetzheim, Chirikos, Li, Drews, & Iezzoni, 2006b).…”

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confidence: 99%

Physical Access Barriers to Care for Diagnosis and Treatment of Breast Cancer Among Women With Mobility Impairments

Iezzoni¹,

Kilbridge²,

Park³

2010

Oncology Nursing Forum

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Objective-To explore the perceptions of breast cancer patients with mobility impairments of the physical accessibility of health care equipment and facilities Research Approach-One-to two-hour individual interviews, audiotaped Setting-Interviews in homes or workplaces or by telephoneParticipants-20 women with chronic mobility impairments who developed early-stage breast cancer before age 60; 3 recruited from oncologist panels and 17 from informal networks of disabled women nationwide Methodologic Approach-Qualitative analyses of interview transcripts to identify common themesMain Research Variables-Extent and nature of mobility impairments; concerns raised by interviewees about barriers to careFindings-The 20 participants identified problems with inaccessible equipment, including mammography machines, examining tables, and weight scales. Sometimes women needed to insist on being transferred to an examining table when physicians preferred to examine them seated in their wheelchairs. When staff would transfer them, patients feared injury; patients felt badly when clinical personnel were injured during transfers. Other problems included difficulties with positioning and handling patients' uncontrollable movements. Even when clinical sites had accessible equipment, this equipment was sometimes unavailable when the woman arrived for her appointment.Conclusions-Women with major mobility problems who developed breast cancer confronted numerous physical barriers during the course of their breast cancer diagnosis and treatment.Interpretation-With the aging of "baby boomers," increasing numbers of persons seeking health care services will have mobility impairments. Health care providers should plan proactively to accommodate these patients by considering accessibility whenever they acquire new equipment, renovate older structures, or build new facilities. They should also establish policies and procedures to assure that accessible equipment is available during appointments of people who Most findings relating to mammography and breast cancer care disparities come from large population-based surveys or cancer registry data, without sufficient detail to identify specific causes (Chan et al., 1999;Chevarley et al., 2006;Iezzoni et al., 2000;Iezzoni et al., 2001;Iezzoni et al., 2008; McCarthy, Ngo, Roetzheim, Chirikos, Li, Drews, & Iezzoni, 2006a;Wei et al., 2006). To explore how physical access affects breast cancer diagnosis and treatment experiences, we conducted in-depth, individual interviews with 20 women with chronic mobility impairments who developed early stage breast cancer. Although this study focuses specifically on breast cancer, we identify issues that all clinicians and health care facilities should consider more generally to improve physical access for their patients. Methods Conceptual ModelAs our conceptual model, we used definitions from the International Classification of Functioning, Disability and Health ( Study ParticipantsWe recruited English-speaking women diagnosed with early stage breast ca...

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Early Stage Breast Cancer Treatments for Younger Medicare Beneficiaries with Different Disabilities

Cited by 33 publications

References 32 publications

The association of race/ethnicity, insurance status, and socioeconomic factors with breast cancer care

The association of race/ethnicity, insurance status, and socioeconomic factors with breast cancer care

Radiotherapy and death from cerebrovascular disease in patients with primary brain tumors

Physical Access Barriers to Care for Diagnosis and Treatment of Breast Cancer Among Women With Mobility Impairments

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