Beyond claims data: Assessing the problem of access to radiation therapy for low-income women with breast cancer

Introduction: Research suggests that one-third of low-income early-stage breast cancer patients do not get radiation therapy (RT) after breast conserving surgery (BCS). This study presents 2007-2008 rates of underuse of RT after BCS among Medicaid-insured women in North Carolina.

Methods: UNC Rapid Case Ascertainment (RCA) worked with registrars at 40 hospitals to identify women diagnosed with early-stage breast cancer. Registry data were matched to Medicaid records. Claims were reviewed for six months post-surgery. RCA obtained pathology reports and operative notes for women with claims for BCS but not RT. Women without evidence of RT after BCS were contacted by phone for a qualitative interview study.

Results: Of the 180 Medicaid-insured women with Stage I/II breast cancer, claims indicated that 63 received BCS but not RT within 6 months of surgery. Fourteen additional women were excluded based on path reports or op notes (e.g., RT, mastectomy, Stage III). Of 49 women contacted, 20 were lost to follow-up (e.g., physician refusal, bad phone number, deceased). Four were ineligible based on self-report (e.g., mastectomy, Stage III). Nineteen self-reported RT after BCS. Only 2 Medicaid-insured women with Stage I/II breast cancer have received BCS but not RT.

Discussion: The rate of non-receipt of RT after BCS for Medicaid-insured women seems much lower than reported in claims-based or single-facility studies. Given the complex organization of the health care system, obtaining a comprehensive picture of breast cancer care for women insured by Medicaid is challenging. Accuracy requires information from multiple sources, including the patient.