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.1 A primary factor in underuse of radiation therapy was younger patients having children aged < 7 years.
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.
Disclosure: 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.
1. Pan IW, Smith BD, Shih Y-CT: Factors contributing to underuse of radiation among younger women with breast cancer. J Natl Cancer Institute (early release online, December 7, 2013).