(P119) Effect of Economic Environment on Use of Postlumpectomy Radiation Therapy for Stage I Breast Cancer

OncologyOncology Vol 28 No 1S
Volume 28
Issue 1S

An investigation of the association between deteriorating economic environment and utilization of postlumpectomy radiation therapy (PLRT) using a difference-in-differences (DID) model.

Debra Nana Yeboa, MD, Xiao Xu, PhD, James B. Yu, MD; Yale School of Medicine

Introduction: Our prior work indicates that the receipt of postlumpectomy radiation therapy (PLRT) for early-stage breast cancer decreased from 80.7% in 2004 to 76.8% in 2009 among women over 40 years of age. Whether this decrease in the receipt of appropriate radiotherapy care for breast cancer was associated with economic factors is unknown. We therefore investigated the association between deteriorating economic environment and utilization of PLRT using a difference-in-differences (DID) model.

Methods: Using the Surveillance, Epidemiology, and End Results (SEER) registry database, we identified 21,816 women aged 40–85 years undergoing lumpectomy in 2004 or 2008. County-level unemployment rate was obtained from the US Department of Labor, Bureau of Labor Statistics and linked to SEER data by each patient’s zip code of residence. We used county unemployment rate as a marker for the economic environment of the patient’s residence area and compared 2004 and 2008 data, because the most recent economic recession began in 2007. To assess the impact of increasing unemployment, we focused our analysis on the 12,568 patients residing in counties that had an unemployment rate below 5.57% in 2004 (ie, the mean unemployment rate of the cohort in 2004). Counties with unemployment rates that rose from below 5.57% in 2004 to above 5.57% in 2008 were defined as having “increasing unemployment,” while those that consistently had rates below 5.57% in 2004 and 2008 were defined as having “stable unemployment.” Via a logistic regression, the DID model assessed the impact of “increasing unemployment” on the likelihood of receiving PLRT, while data on patients from counties with “stable unemployment” were used as a control condition to account for secular changes that occurred between those years.

Results: Receipt of PLRT decreased from 80.3% in 2004 to 79.8% in 2008 among women who lived in counties with increasing unemployment (P = not significant [NS]). In contrast, in counties where the unemployment rate stayed consistently low, the receipt of PLRT increased from 81.7% to 82.4% (P = NS). Unadjusted analysis suggests that patients living in counties that had increasing unemployment were significantly less likely to receive PLRT, compared with those living in counties that had consistently low unemployment (odds ratio [OR] = 0.88; 95% confidence interval [CI], 0.80–0.96). However, in the DID model, the interaction term between increasing vs stable unemployment and year was not statistically significant, indicating that increasing unemployment was not associated with an additional negative impact beyond other unmeasured variables that also changed from 2004 through 2008 (OR = 0.93; 95% CI, 0.78–1.11). In the adjusted model, being Medicare-age-eligible was associated with higher likelihood of PLRT receipt, while black race and estrogen receptor–negative status were associated with lower receipt of PLRT.

Conclusion: The impact of increasing vs stable unemployment rate in patients’ residence areas was not significantly associated with lower PLRT receipt. This indicates that the lower rate of PLRT receipt in 2008 in comparison with 2004 was due to multiple factors not completely encompassed by increasing unemployment alone.

Articles in this issue

(P113) Age and Marital Status Are Associated With Choice of Mastectomy in Patients Eligible for Breast Conservation Therapy
(P112) Single-Institution Experience With Intrabeam IORT for Treatment of Early-Stage Breast Cancer
(P110) Breast Cancer Before Age 40: Current Patterns in Clinical Presentation and Local Management
(P111) Accelerated Partial-Breast Irradiation With Multicatheter High-Dose-Rate Brachytherapy: Feasibility and Results in a Private Practice Cohort
(P115) Breast Cancer Laterality Does Not Influence Overall Survival in a Large Modern Cohort: Implications for Radiation-Related Cardiac Mortality
(P117) Anatomical Variations and Radiation Technique for Breast Cancer
(P116) Bilateral Immediate DIEP Reconstruction and Postmastectomy Radiotherapy: Experience at a Tertiary Care Institution
(P118) Metadherin Overexpression Is Associated With Improved Locoregional Control After Mastectomy
(P119) Effect of Economic Environment on Use of Postlumpectomy Radiation Therapy for Stage I Breast Cancer
(P120) Immediate Versus Delayed Reconstruction After Mastectomy in the United States Medicare Breast Cancer Patient
(P121) Trend in Age and Racial Disparities in the Receipt of Postlumpectomy Radiation Therapy for Stage I Breast Cancer: 2004–2009
(P122) Streamlining Referring Physicians Orders With ‘Reflex Testing’ Significantly Decreases Time to Resolution for Abnormal Screening Mammograms
(P123) National Trends in the Local Management of Early-Stage Paget Disease of the Breast
(P124) Effect of Inhomogeneity on Cardiac and Lung Dose in Partial-Breast Irradiation Using HDR Brachytherapy
(P125) Breast Cancer Outcomes With Anthracycline-Based Chemotherapy for Residual Disease Burden After Full-Dose Neoadjuvant Chemotherapy and Surgery Followed by Radiation Treatment
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