Characteristics of care facilities may influence when elderly breast cancer patients receive radiation therapy
Structural/organizational characteristics of surgical facilities are significant predictors of radiation therapy (RT) initiation at 2, 6, and 12 months after breast-conserving surgery (BCS) among elderly women, and partially explain racial/ethnic variation in RT timing, concludes a new study. North Carolina-based researchers examined Surveillance Epidemiology and End Results data linked to Medicare claims to identify women aged 65 and older diagnosed with stages I-III breast cancer and treated with BCS in 1994–2002. They examined the role of distance to RT providers, presence of on-site radiation services, surgical facility type/ownership, and size of surgical facility in explaining racial/ethnic variation in the timing of initiation of guideline-recommended RT after BCS.
Increasing distance to RT providers generally was associated with lower odds of RT initiation at each time interval examined, with greater evidence of an access burden for Hispanic women. Delays in initiation of RT were associated with Federal and larger hospitals where care may be more fragmented. When the data were fully adjusted, racial/ethnic disparities in RT initiation disappeared within 6 and 12 months. The researchers concluded that identifying modifiable health system-level factors associated with quality cancer care (such as the availability of transportation) may help target policy interventions that can reduce disparities in outcomes. This study was supported in part by the Agency for Healthcare Research and Quality (T32 HS00032).
See "Structural/organizational characteristics of health services partly explain racial variation in timeliness of radiation therapy among elderly breast cancer patients," by Stephanie B. Wheeler, Ph.D., William R. Carpenter, Ph.D., Jeffrey Peppercorn, M.D., M.P.H., and others in Breast Cancer Research and Treatment 133, pp. 333-345, 2012.