Treatment of local breast carcinoma in Florida: The role of the distance to radiation therapy facilities

Lydia Voti, Lisa C. Richardson, Isildinha Reis, Lora E. Fleming, Jill MacKinnon, Jan Willem W Coebergh

Research output: Contribution to journalArticle

75 Citations (Scopus)

Abstract

BACKGROUND. Breast-conserving surgery combined with radiation (BCSR) is the recommended alternative treatment to mastectomy for local breast carcinoma. However, limited access to healthcare may result in more extensive surgical treatment. The effect of distance to radiation therapy facilities on the likelihood of receiving BCSR was examined in Florida. METHODS. Local breast carcinomas reported to Florida's statewide registry between July, 1997, and December, 2000 were linked to the Agency of Healthcare Administration inpatient and outpatient databases to supplement the registry's treatment data, resulting in 18,903 local breast carcinoma cases treated with BCSR or mastectomy. The odds of receiving BCSR were modeled as a function of distance to the closest radiation therapy facility, adjusting for health insurance, age, race/ ethnicity, and marital status. RESULTS. Distance to the closest radiation therapy facility was negatively associated with BCSR, with the odds ratio (OR) decreasing by 3% per 5-mile increase in distance. Compared with the uninsured, privately insured women were 49% more likely to receive BCSR (OR of 1.49; 95% confidence interval [95% CI], 1.20-1.86) and Medicare patients were 37% more likely (OR of 1.37; 95% CI, 1.09-1.72). Age at diagnosis was negatively associated, reducing the odds of BCSR by 1% per year increase in age. Compared with white non-Hispanic, Hispanic women were 38% less likely to receive BCSR (OR of 0.62; 95% CI, 0.55-0.71). Married women were 23% more likely to receive BCSR compared with singles (OR of 1.23; 95% CI, 1.09-1.40); women who were separated, divorced, or widowed did not differ significantly from single women. CONCLUSIONS. Distance to radiation therapy facilities may negatively impact the likelihood of BCSR in Florida. Age at diagnosis, insurance type, race/ethnicity, and marital status were associated with BCSR. Future efforts should target the uninsured, Hispanics, the elderly, and the unmarried women to reduce disparities in the administration of BCSR for local breast carcinoma.

Original languageEnglish
Pages (from-to)201-207
Number of pages7
JournalCancer
Volume106
Issue number1
DOIs
StatePublished - Jan 1 2006

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Segmental Mastectomy
Radiotherapy
Radiation
Breast Neoplasms
Odds Ratio
Therapeutics
Confidence Intervals
Mastectomy
Marital Status
Hispanic Americans
Registries
Delivery of Health Care
Widowhood
Divorce
Health Insurance
Medicare
Insurance
Inpatients
Outpatients
Databases

Keywords

  • Geographic access to care
  • Health insurance
  • Local breast carcinoma
  • Patterns of care
  • Race-ethnicity
  • Treatment disparities

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Voti, L., Richardson, L. C., Reis, I., Fleming, L. E., MacKinnon, J., & Coebergh, J. W. W. (2006). Treatment of local breast carcinoma in Florida: The role of the distance to radiation therapy facilities. Cancer, 106(1), 201-207. https://doi.org/10.1002/cncr.21557

Treatment of local breast carcinoma in Florida : The role of the distance to radiation therapy facilities. / Voti, Lydia; Richardson, Lisa C.; Reis, Isildinha; Fleming, Lora E.; MacKinnon, Jill; Coebergh, Jan Willem W.

In: Cancer, Vol. 106, No. 1, 01.01.2006, p. 201-207.

Research output: Contribution to journalArticle

Voti, L, Richardson, LC, Reis, I, Fleming, LE, MacKinnon, J & Coebergh, JWW 2006, 'Treatment of local breast carcinoma in Florida: The role of the distance to radiation therapy facilities', Cancer, vol. 106, no. 1, pp. 201-207. https://doi.org/10.1002/cncr.21557
Voti, Lydia ; Richardson, Lisa C. ; Reis, Isildinha ; Fleming, Lora E. ; MacKinnon, Jill ; Coebergh, Jan Willem W. / Treatment of local breast carcinoma in Florida : The role of the distance to radiation therapy facilities. In: Cancer. 2006 ; Vol. 106, No. 1. pp. 201-207.
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abstract = "BACKGROUND. Breast-conserving surgery combined with radiation (BCSR) is the recommended alternative treatment to mastectomy for local breast carcinoma. However, limited access to healthcare may result in more extensive surgical treatment. The effect of distance to radiation therapy facilities on the likelihood of receiving BCSR was examined in Florida. METHODS. Local breast carcinomas reported to Florida's statewide registry between July, 1997, and December, 2000 were linked to the Agency of Healthcare Administration inpatient and outpatient databases to supplement the registry's treatment data, resulting in 18,903 local breast carcinoma cases treated with BCSR or mastectomy. The odds of receiving BCSR were modeled as a function of distance to the closest radiation therapy facility, adjusting for health insurance, age, race/ ethnicity, and marital status. RESULTS. Distance to the closest radiation therapy facility was negatively associated with BCSR, with the odds ratio (OR) decreasing by 3{\%} per 5-mile increase in distance. Compared with the uninsured, privately insured women were 49{\%} more likely to receive BCSR (OR of 1.49; 95{\%} confidence interval [95{\%} CI], 1.20-1.86) and Medicare patients were 37{\%} more likely (OR of 1.37; 95{\%} CI, 1.09-1.72). Age at diagnosis was negatively associated, reducing the odds of BCSR by 1{\%} per year increase in age. Compared with white non-Hispanic, Hispanic women were 38{\%} less likely to receive BCSR (OR of 0.62; 95{\%} CI, 0.55-0.71). Married women were 23{\%} more likely to receive BCSR compared with singles (OR of 1.23; 95{\%} CI, 1.09-1.40); women who were separated, divorced, or widowed did not differ significantly from single women. CONCLUSIONS. Distance to radiation therapy facilities may negatively impact the likelihood of BCSR in Florida. Age at diagnosis, insurance type, race/ethnicity, and marital status were associated with BCSR. Future efforts should target the uninsured, Hispanics, the elderly, and the unmarried women to reduce disparities in the administration of BCSR for local breast carcinoma.",
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N2 - BACKGROUND. Breast-conserving surgery combined with radiation (BCSR) is the recommended alternative treatment to mastectomy for local breast carcinoma. However, limited access to healthcare may result in more extensive surgical treatment. The effect of distance to radiation therapy facilities on the likelihood of receiving BCSR was examined in Florida. METHODS. Local breast carcinomas reported to Florida's statewide registry between July, 1997, and December, 2000 were linked to the Agency of Healthcare Administration inpatient and outpatient databases to supplement the registry's treatment data, resulting in 18,903 local breast carcinoma cases treated with BCSR or mastectomy. The odds of receiving BCSR were modeled as a function of distance to the closest radiation therapy facility, adjusting for health insurance, age, race/ ethnicity, and marital status. RESULTS. Distance to the closest radiation therapy facility was negatively associated with BCSR, with the odds ratio (OR) decreasing by 3% per 5-mile increase in distance. Compared with the uninsured, privately insured women were 49% more likely to receive BCSR (OR of 1.49; 95% confidence interval [95% CI], 1.20-1.86) and Medicare patients were 37% more likely (OR of 1.37; 95% CI, 1.09-1.72). Age at diagnosis was negatively associated, reducing the odds of BCSR by 1% per year increase in age. Compared with white non-Hispanic, Hispanic women were 38% less likely to receive BCSR (OR of 0.62; 95% CI, 0.55-0.71). Married women were 23% more likely to receive BCSR compared with singles (OR of 1.23; 95% CI, 1.09-1.40); women who were separated, divorced, or widowed did not differ significantly from single women. CONCLUSIONS. Distance to radiation therapy facilities may negatively impact the likelihood of BCSR in Florida. Age at diagnosis, insurance type, race/ethnicity, and marital status were associated with BCSR. Future efforts should target the uninsured, Hispanics, the elderly, and the unmarried women to reduce disparities in the administration of BCSR for local breast carcinoma.

AB - BACKGROUND. Breast-conserving surgery combined with radiation (BCSR) is the recommended alternative treatment to mastectomy for local breast carcinoma. However, limited access to healthcare may result in more extensive surgical treatment. The effect of distance to radiation therapy facilities on the likelihood of receiving BCSR was examined in Florida. METHODS. Local breast carcinomas reported to Florida's statewide registry between July, 1997, and December, 2000 were linked to the Agency of Healthcare Administration inpatient and outpatient databases to supplement the registry's treatment data, resulting in 18,903 local breast carcinoma cases treated with BCSR or mastectomy. The odds of receiving BCSR were modeled as a function of distance to the closest radiation therapy facility, adjusting for health insurance, age, race/ ethnicity, and marital status. RESULTS. Distance to the closest radiation therapy facility was negatively associated with BCSR, with the odds ratio (OR) decreasing by 3% per 5-mile increase in distance. Compared with the uninsured, privately insured women were 49% more likely to receive BCSR (OR of 1.49; 95% confidence interval [95% CI], 1.20-1.86) and Medicare patients were 37% more likely (OR of 1.37; 95% CI, 1.09-1.72). Age at diagnosis was negatively associated, reducing the odds of BCSR by 1% per year increase in age. Compared with white non-Hispanic, Hispanic women were 38% less likely to receive BCSR (OR of 0.62; 95% CI, 0.55-0.71). Married women were 23% more likely to receive BCSR compared with singles (OR of 1.23; 95% CI, 1.09-1.40); women who were separated, divorced, or widowed did not differ significantly from single women. CONCLUSIONS. Distance to radiation therapy facilities may negatively impact the likelihood of BCSR in Florida. Age at diagnosis, insurance type, race/ethnicity, and marital status were associated with BCSR. Future efforts should target the uninsured, Hispanics, the elderly, and the unmarried women to reduce disparities in the administration of BCSR for local breast carcinoma.

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