Abstract P1-09-05: Does socioeconomic status (SES) influence receipt of guideline concordant care in older women with breast cancer: Findings from a Centers for Disease Control and Prevention national program of cancer registries (NPCR) patterns of care study
Authors: Ursem C , Fleming ST , Sabatino S , Wu X-C , Wilson JF , Lipscomb J , Cress R , Anderson R , Kimmick G 
Published: August 2014

Background: Lower SES is associated with worse breast cancer outcomes in general. Disparities by SES have not been well studied in older cancer patients. Here, we examined differences in presentation and treatment patterns by SES in older cancer patients.

Methods: The NPCR's Patterns of Care study reabstracted the medical records of breast cancer cases diagnosed in 2004 from 7 state cancer registries. For this study, we included women ≥65 years old with stage 0-III breast cancer. SES was defined by insurance status: non-poor if Medicare (M) or poor if Medicare plus Medicaid (dMM). Receipt of adjuvant chemotherapy, radiation (RT) after breast conserving surgery (BCS), and endocrine therapy were compared by insurance status. We used multiple logistic regression to evaluate the role of age, race, comorbidity and tumor characteristics in the differences in receipt of treatment components, both in separate models by insurance status and then in a pooled model that included insurance status as a predictor.

Results: Included were 1,844 women, with insurance status M in 1,585 and dMM in 259. Patients with dMM (vs M) were more likely nonwhite (38.1% vs 10.1%, p&lt;0.001), had higher comorbidity (p = 0.01), higher stage (p = 0.03), and larger tumors (p = 0.002). M and dMM groups were similar with respect to age distribution, tumor grade, lymph node status (LN), hormone receptor status, and HER2 status. Overall, there were similar rates of BCS vs mastectomy and use of adjuvant chemotherapy (17.6% vs 13.5%, p = 0.099). Endocrine therapy use was less likely in dMM-insured patients (45.4% vs 55.7%, p = 0.0175). In multivariate analyses, for M-insured patients, lower BCS rate was associated with higher stage (OR 0.45 for stage I and 0.088 for stage III, vs stage 0, p&lt;0.05) and larger tumor size, vs 10 mm or less(OR 0.566 for 11-20 mm, p&lt;0.05, and 0.390 for 20mm and greater, p&lt;0.05); severe comorbidity predicted less RT after BCS (OR 0.457, p&lt;0.05); and larger tumor size (vs 10 mm or less) predicted higher likelihood of receiving chemotherapy (OR 3.93 for 11-20 mm, p&lt;0.05, and 12.65 for 20mm and greater, p&lt;0.05). In dMM-insured patients, the only significant relationship was that higher age predicted less chemotherapy use (OR 0.788, p&lt;0.05). In models that included insurance status, this covariate was significant only in the model for chemotherapy – dMM was associated with less chemotherapy use (OR 0.38, p&lt;0.05).

Conclusions: Despite presenting with higher stage and larger tumors, older breast cancer patients with dual-Medicare-Medicaid insurance were less likely than those with Medicare-only to receive adjuvant chemotherapy, controlling for age, race, comorbidity and tumor characteristics. Research is needed to further explore the disparity in adjuvant chemotherapy use among poor older patients.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-09-05.