Underuse of Radiation Therapy After Breast Conservation Surgery in Puerto Rico: A Puerto Rico Central Cancer Registry–Health Insurance Linkage Database Study

Abstract

PurposeTo identify rates of postoperative radiation therapy (RT) after breast conservation surgery (BCS) in women with stage I or II invasive breast cancer treated in Puerto Rico and to examine the sociodemographic and health services characteristics associated with variations in receipt of RT.MethodsThe Puerto Rico Central Cancer Registry–Health Insurance Linkage Database was used to identify patients diagnosed with invasive breast cancer between 2008 and 2012 in Puerto Rico. Claims codes identified the type of surgery and the use of RT. Logistic regression models were used to examine the independent association between sociodemographic and clinical covariates.ResultsAmong women who received BCS as their primary definitive treatment, 64% received adjuvant RT. Significant predictors of RT after BCS included enrollment in Medicare (odds ratio [OR], 2.14; 95% CI, 1.46 to 3.13; P ≤ .01) and dual eligibility for Medicare and Medicaid (OR, 1.61; 95% CI, 1.14 to 2.27; P < .01). In addition, it was found that RT was more likely to have been received in certain geographic locations, including the Metro-North (OR, 2.20; 95% CI, 1.48 to 3.28; P < .01), North (OR, 1.78; 95% CI, 1.20 to 2.64; P < .01), West (OR, 4.04; 95% CI, 2.61 to 6.25; P < .01), and Southwest (OR, 2.79; 95% CI, 1.70 to 4.59; P < .01). Furthermore, patients with tumor size > 2.0 cm and ≤ 5.0 cm (OR, 0.61; 95% CI, 0.40 to 0.93; P = .02) and those with tumor size > 5.0 cm (OR, 0.37; 95% CI, 0.15 to 0.92; P = .03) were found to be significantly less likely to receive RT.ConclusionUnderuse of RT after BCS was identified in Puerto Rico. Patients enrolled in Medicare and those who were dually eligible for Medicaid and Medicare were more likely to receive RT after BCS compared with patients with Medicaid alone. There were geographic variations in the receipt of RT on the island.

Squamous Cell Carcinoma of the Anus Incidence, Mortality, and Survival Among the General Population and Persons Living With HIV in Puerto Rico, 2000-2016

“…30 , 31 This could potentially lead to more advanced stage at diagnosis and/or delayed access to preventive and treatment services as research has shown that patients with public health coverage in PR experience longer waiting times to schedule an appointment, to see a specialist, and to receive cancer treatment. 10 , 30 , 32 – 35 More studies are needed to understand how type of health coverage affects survival in PR.…”

Resultado oncológico de cirugía conservadora con adyuvancia en cáncer de mama, Hospital San Felipe, Tegucigalpa

“…17 También se asemeja a estudios realizados en Estados Unidos y Puerto Rico donde el 66.2% y 64.0% de mujeres recibieron radioterapia adyuvante post cirugía conservadora en un periodo de 10 años, con tasa anual de 60.9%-70.1%. 14,20 Sin embargo, la totalidad de las pacientes deben recibir radioterapia posterior a la cirugía conservadora, debido a la reducción del 70.0% de las recurrencias locales y 50.0% la tasa anual de falla en los primeros 10 años. 21,22 Hasta la fecha no se ha identificado un subgrupo de pacientes en el que la radioterapia pueda ser seguramente omitida.…”

“…Se registró datos sociodemográficos, estadio clínico pre-y post-operatorio, tratamiento y sobrevida. Resultados: De 49 pacientes, 59.2% (29) >50 años, 71.4% (35) procedencia urbana, 61.2% (30) estadio IIA, las modalidades terapéuticas fueron radioterapia 73.5% (36), hormonoterapia 69.4% (34), quimioterapia 40.8% (20). La combinación más frecuente fue radioterapia/hormonoterapia 46.9% (23); 26.5% (13) recibió monoterapia.…”

“…ABSTRACT. Background: Breast cancer is the most frequently diagnosed malignancy in women, representing almost 1 in every 4 (20). The most frequent combination was radiotherapy/endocrine therapy in 46.9% (23); 26.5% (13) received monotherapy.…”

Use of palliative radiotherapy among patients with metastatic non-small-cell lung cancer in Puerto Rico

“…Also, the lack of training, protocols, and palliative care teams and specialists [ 9 ] may exacerbate the gap between the need for palliative care services and availability of these services in the island. This is of great concern because lack of appropriate and timely use of oncologic health services may contribute to the observed differences in cancer-related health outcomes and survival [ 7 , 10 ]. Therefore, understanding the barriers to standards of care is essential for addressing the disparities in the burden associated with symptom distress experienced by the NSCLC population, which can ultimately result in a low quality of life for these patients [ 11 ].…”