Patients with Medicaid coverage or without insurance are more likely to not receive radiation after lumpectomy.
Norman Yeh, Arya Amini, MD, Christine Fisher, MD; University of Colorado Denver
PURPOSE: After a lumpectomy in early-stage breast cancer, adjuvant radiation therapy as a component of breast conservation is standard of care. The purpose of this study was to evaluate patterns of care for postlumpectomy radiation according to insurance status.
PATIENT ANDMETHODS: The Surveillance, Epidemiology, and End Results (SEER) database was examined for patients with breast cancer aged under 65 years and with a stage of T1N0. The database was queried from 2007 to 2011, with a total of 72,257 patients included in the analysis. Multinomial logistic regression was used to assess patient and tumor characteristics under multivariable analysis.
RESULTS: All patients had the following insurance status: non-Medicaid insurance (90%), any Medicaid (9%), and uninsured (2%). Medicaid (odds ratio [OR] = 0.77; 95% confidence interval [CI], 0.66–0.89; P < .001) and uninsured status (OR = 0.53; 95% CI, 0.40–0.71; P < .001) were more likely to not receive postlumpectomy radiation on multivariate analysis after adjusting for age, race, sex, residence (urban vs rural), marital status, percentage of county below federal poverty limit, percentage of county below ninth grade education, and estrogen receptor (ER)/progesterone receptor (PR)/human epidermal growth factor receptor type 2 (HER2) status. Additional statistically significant predictors for patients not receiving postlumpectomy radiation included African-American race (OR = 0.86), being unmarried (OR = 0.88), living in a county with a higher percentage of residents with less than a ninth grade education (OR = 0.60), and higher percent of county below the federal poverty level (OR = 0.57). Among uninsured patients, there was also a significant association with African-American race and residence in a county with a higher percentage of people below the federal poverty level.
CONCLUSION: Patients with Medicaid coverage or without insurance are more likely to not receive radiation after lumpectomy.
Proceedings of the 97th Annual Meeting of the American Radium Society - americanradiumsociety.org