Effects of Distance to Care and Rural or Urban Residence on Receipt of Radiation Therapy Among North Carolina Medicare Enrollees With Breast Cancer

Wheeler, Stephanie B.; Kuo, Tzy Mey; Durham, Danielle D.; Frizzelle, Brian G.; Reeder‐Hayes, Katherine E.; Meyer, Anne Marie

doi:10.18043/ncm.75.4.239

Cited by 43 publications

(55 citation statements)

References 49 publications

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“…Thus, even in the rural areas of the U.S. served by the NRECA, geographic access to a screening facility per se does not seem to be a large barrier. This is consistent with data regarding impact of distance on receipt of radiation therapy for breast cancer among rural women [27].…”

Section: Discussionsupporting

confidence: 92%

Breast cancer screening utilization and understanding of current guidelines among rural U.S. women with private insurance

Peppercorn¹,

Houck

Beri

et al. 2015

Breast Cancer Res Treat

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Women living in rural areas of the U.S. face disparities in screening mammography and breast cancer outcomes. We sought to evaluate utilization of mammography, awareness of screening guidelines, and attitudes towards screening among rural insured U.S. women. We conducted a cross-sectional self-administered anonymous survey among 2000 women aged 40-64 insured by the National Rural Electric Cooperative Association, a non-profit insurer for electrical utility workers in predominantly rural areas across the U.S. Outcomes included mammographic screening in the past year, screening interval, awareness of guidelines, and perceived barriers to screening. 1588 women responded to the survey (response rate 79.4 %). 74 % of respondents lived in a rural area. Among women aged 40-49, 66.5 % reported mammographic screening in the past year. 46 % received annual screening, 32 % biennial screening, and 22 % rare/no screening. Among women aged 50-64, 77.1 % reported screening in the past year. 63 % received annual screening, 25 % biennial screening, and 12 % rare/no screening. The majority of women (98 %) believed that the mammography can find breast cancer early and save lives. Less than 1 % of younger women, and only 14 % of women over age 50 identified the recommendations of the U.S. Preventative Services Screening Task Force as the current expert recommendations for screening. Screening practices tended to follow perceived guideline recommendations. When rural U.S. women over age 40 have insurance, most receive breast cancer screening. The screening guidelines of cancer advocacy groups and specialty societies appear more influential and widely recognized than those of the U.S. preventative services taskforce.

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Section: Discussionsupporting

confidence: 92%

Breast cancer screening utilization and understanding of current guidelines among rural U.S. women with private insurance

Peppercorn¹,

Houck

Beri

et al. 2015

Breast Cancer Res Treat

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“…Studies of treatment decisions and provider specialty have found that oncologists are willing to use more aggressive and advanced methods of treatment [40,41]. Moreover, patients treated by an oncology surgeon may have shorter travel distances to access specialty care and oncology treatment centers, making them more likely to undergo treatments that require repeated visits, such as BCS+RT [42]. Therefore, it is not surprising that women in this study who resided in areas with a high density of mammography screening and oncology treatment centers were less likely to have BCS only or mastectomy.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Initial Local Treatment Received for Early-Stage Breast Cancer between Elderly Women in Appalachia and a United States - Based Population: Good and Bad News

LeMasters

Madhavan

Sambamoorthi

2016

Global J. Breast Can. Res.

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Background Breast conserving surgery (BCS) followed by radiation therapy (RT) (BCS+RT) is as effective for long-term survival of invasive early-stage breast cancer (ESBC) as mastectomy, and is the local treatment option selected by the majority of women with ESBC. Women of older age and vulnerable socio-demographic characteristics are at greater risk for receiving substandard (BCS only) and non-preferred treatments (mastectomy), such as populations of women from the Appalachian region of United States. Methods Using a retrospective cohort study design, we identified 26,106 patients from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked dataset and 811 patients from the West Virginia Cancer Registry (WVCR)-Medicare dataset age ≥ 66 diagnosed from 2003 to 2006 with stage I–II breast cancer. Multivariable logistic regression models estimated type of initial treatment received between WVCR-Medicare and SEER-Medicare patients, and the association with type of treatment. Results Overall, women in WV were 0.82 (95% CI 0.68–0.99) and 0.70 (95% CI 0.58–0.84) times less likely to have mastectomy or BCS only vs. BCS+RT, than those in SEER regions. Women in WV of increasing age, greater comorbidity, stage II disease, and non-white race were more likely to have mastectomy or BCS only vs. BCS+RT, whereas, those residing in areas of higher income, higher education, and metro status were less likely, than similarly characterized women from SEER regions. Conclusions Findings from this study suggest that the magnitude of disparities in breast cancer treatment between groups of women with more and less resources are even greater in the Appalachian region, than they are among US populations. Improving access to oncology treatment services, as well as, the implementation of patient navigation programs are needed to improve patterns of initial treatment for ESBC among at-risk populations.

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“…5,25 In addition, we imagine that those patients who can overcome the travel distance may be willing to do so for an isolated treatment, like surgery, but not for ongoing care, as in the case of chemotherapy. However, rural patients are more willing to travel further distances for care 26,27 and racial/ethnic minorities are more likely to live in close proximity to gynecologic oncologists. 28 As such, it is critical to understand who stands to benefit the most from continued HV center care, to both invest resources to support continued travel for high-risk patients, while avoiding unnecessary travel burden for low-risk patients.…”

Section: Commentmentioning

confidence: 99%

Referral patterns between high- and low-volume centers and associations with uterine cancer treatment and survival: a population-based study of Medicare, Medicaid, and privately insured women

Doll

Meng

Gehrig

et al. 2016

American Journal of Obstetrics and Gynecology

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Background High-volume (HV) center surgery and gynecologic oncology care are associated with improved outcomes for women with uterine cancer. Referral patterns, from biopsy through to chemotherapy, may have patients interacting with HV centers for all, a portion, or none of their care. The relative frequency, the underlying factors that contribute to referral, and the potential impact of these referral patterns on treatment outcomes are unknown. Objective To analyze the referral patterns and subsequent impact of care sites on treatment for women with high and low risk uterine cancer. Methods This is a population-based retrospective cohort study of uterine cancer cases from 2004–09 in North Carolina. Using state cancer registry files linked to Medicare, Medicaid, and private payer insurance claims, we analyzed referral and treatment patterns by annual surgical volume (High ≥ 12/year). We examined clinical and demographic factors associated with referral and used modified Poisson regression to evaluate risk of referral, lymphadenectomy and chemotherapy. Stratified Kaplan Meier plots and Cox proportional hazard models were used to examine survival. Results A total of 2,053 women were analyzed, including 34% (n=677) with Grade 3 histology. Of 1,630 (80%) of women with pre-operative biopsies, referral patterns (Biopsy to Surgery) were: LV to HV (n=652, 40%), followed by HV to HV (n=605, 37%), then LV to LV (n=318, 20%), and the rare HV to LV (n=50, 3%). Women retained in Low-Volume centers after biopsy were older, were less likely to have private insurance, and had more comorbidities. High-risk histology (aRR 1.14, 95%CI: 1.04–1.25) was positively associated with referral, while Medicaid insurance was negatively associated with referral (aRR 0.64, 95%CI: 0.42–0.96). Most women (74%, n=1,557) had surgery at HV centers. Lymphadenectomy was less likely at Low-Volume (LV) centers (aRR 0.71, 95%CI: 0.64–0.77). Similarly, for high-risk patients, the relationship between LV center surgery and subsequent chemotherapy was aRR 0.71 (95%CI: 0.48–1.02). Of 290 women who received chemotherapy, the referral patterns (Surgery to Chemotherapy) were: HV- All (HV to HV), HV-Hybrid (HV to LV, or LV to HV), and HV-None (LV to LV). 36% (n=104/290) received chemotherapy at a LV center, the majority (68%, n=71/104) of whom were referred from out of HV centers after surgery. Crude, unadjusted mortality risk of chemotherapy recipients differed by referral pattern (Surgery to Chemotherapy): HV-All patients (HR 1.0, referent), followed by HV-Hybrid (HR 1.33, 95%CI: 0.93–1.91) then HV-None patients (RR 1.95, 95%CI:1.24–3.08). Conclusion Most women with uterine cancer treated at High-Volume centers arrive through referral, which is affected by age and type of insurance, in addition to histology. For high-risk women who require chemotherapy, survival may be related to the extent of treatment received at High-Volume centers.

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Effects of Distance to Care and Rural or Urban Residence on Receipt of Radiation Therapy Among North Carolina Medicare Enrollees With Breast Cancer

Cited by 43 publications

References 49 publications

Breast cancer screening utilization and understanding of current guidelines among rural U.S. women with private insurance

Breast cancer screening utilization and understanding of current guidelines among rural U.S. women with private insurance

Comparison of the Initial Local Treatment Received for Early-Stage Breast Cancer between Elderly Women in Appalachia and a United States - Based Population: Good and Bad News

Referral patterns between high- and low-volume centers and associations with uterine cancer treatment and survival: a population-based study of Medicare, Medicaid, and privately insured women

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