Younger Women With Younger Children Less Likely to Receive Radiation Therapy After Breast-Conserving Surgery for Breast Cancer
In a study reported in the Journal of the National Cancer Institute, Pan et al assessed factors associated with noncompliance with recommended radiation therapy following breast-conserving surgery for breast cancer. A primary factor in underuse of radiation therapy was younger patients having children aged < 7 years.
Study Details
The study involved use of the MarketScan Database to identify women aged 20 to 64 years with nonmetastatic breast cancer who had breast-conserving surgery between January 2004 and December 2009 and had continuous insurance enrollment 12 months before and after the date of surgery. Patients who had radiation claims within 1 year after surgery were considered compliant.
Younger Children and Younger Women
Overall, 18,120 (86%) of 21,008 patients received radiation therapy. Compared with women with ≥ 1 child aged < 7 years, those with children aged 7 to 12 years (odds ratio [OR] = 1.32, P = .02), those with children aged 13 to 17 years (OR = 1.41, P = .002), and those with no children or children aged ≥ 18 years (OR = 1.38, P = .001) were significantly more likely to be compliant with radiation therapy on logistic regression analysis.
Compared with women aged ≤ 50 years, those aged 51 to 55 years (OR = 1.22, P = .001), 55 to 60 years (OR = 1.38, P < .001), and 61 to 64 years (OR = 1.28, P < .001) were significantly more likely to receive radiation therapy. Among patients aged ≤ 50 years, those with ≤ 1 child aged < 7 years were significantly less likely to receive radiation therapy than those with children aged 7 to 12 years (OR = 1.40, 95% confidence interval [CI] =1.10–1.78), those with children aged 13 to 17 years (OR = 1.57, 95% CI = 1.23–2.01), and those with no children or children aged ≥ 18 years (OR = 1.40, 95% CI = 1.14–1.74). Although odds ratios were generally higher for family status of children aged ≥ 7 years vs < 7 years for women in older age groups, none were statistically significant.
Other Important Factors
The investigators identified other important factors in radiation therapy compliance as including chemotherapy (OR = 1.33, P < .001), imaging (OR = 1.57, P < .001), enrollment in health maintenance organizations or capitated preferred provider organizations (OR = 0.70, P < .001), travel across census division to receive therapy (OR = 0.72, P < .001), and not being the primary holder of the insurance policy (OR = 1.20, P < .001).
The investigators concluded, “Competing demands from child care can constitute a barrier to complete guideline-concordant breast cancer therapy. Younger patients may be confronted by unique challenges that warrant more attention in future research.”
Ya-Chen Tina Shih, PhD, of University of Chicago, is the corresponding author for the Journal of the National Cancer Institute article.
The study was supported by the Agency for Healthcare Research and Quality, University of Chicago Cancer Research Foundation Women’s Board, and Cancer Prevention & Research Institute of Texas.
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