A Medicare Claims Analysis of Racial and Ethnic Disparities in the Access to Radiation Therapy Services.
Cancer
Health disparities
Medicare
Radiation oncology
Journal
Journal of racial and ethnic health disparities
ISSN: 2196-8837
Titre abrégé: J Racial Ethn Health Disparities
Pays: Switzerland
ID NLM: 101628476
Informations de publication
Date de publication:
04 2023
04 2023
Historique:
received:
01
09
2021
accepted:
12
01
2022
revised:
20
12
2021
pubmed:
23
1
2022
medline:
9
3
2023
entrez:
22
1
2022
Statut:
ppublish
Résumé
Reduced access and utilization of radiation therapy (RT) is a well-documented healthcare disparity observed among racial and ethnic minority groups in the USA and a contributor to the inferior health outcomes observed among Black, Hispanic, and Native American patient groups. What is less understood are the points during the process of care following RT consultation at which patients either fail to complete their prescribed treatment or encounter delays. Identification of those points where significant differences exist among different patient groups may help identify opportunities to close gaps in the access of clinically indicated RT. This analysis examines 261,559 RT episodes abstracted from Medicare claims and beneficiary data between 2016 and 2018 to determine rates of treatment initiation following planning and timeliness of treatment completion for different racial groups. Failure to initiate treatment was observed to be 29.3% relatively greater for Black, Hispanic, and Native American patients than for White and Asian patients. Among episodes for which treatment was initiated, Black and Hispanic patients were observed to require a significantly greater number of calendar days (when adjusted for fraction number) for completion than for White, Asian, and Native American patients. There appears to be a patient cohort for which RT disparities may be more marginal in their effects-allowing for access to consultation and treatment prescription but not for treatment initiation or timely completion of treatment-and may therefore permit effective solutions to help address current differences in cancer outcomes.
Identifiants
pubmed: 35064522
doi: 10.1007/s40615-022-01239-0
pii: 10.1007/s40615-022-01239-0
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
501-508Informations de copyright
© 2022. W. Montague Cobb-NMA Health Institute.
Références
Burbank F, Fraumeni JF Jr. US cancer mortality: nonwhite predominance. J Natl Cancer Inst. 1972;49:649–59.
pubmed: 4647488
Howlader N, Noone AM, Krapcho M, et al. SEER Cancer Statistics Review, 1975–2013. National Cancer Institute, Bethesda, MD. http://seer.cancer.gov/csr/1975_2013/ . Accessed 1 Nov 2021.
Byers TE, Wolf HJ, Bauer KR, et al. The impact of socioeconomic status on survival after cancer in the United States: findings from the National Program of Cancer Registries Patterns of Care Study. Cancer. 2008;113:582–91.
doi: 10.1002/cncr.23567
pubmed: 18613122
Freedman RA, Virgo KS, He Y, et al. The association of race/ethnicity, insurance status, and socioeconomic factors with breast cancer care. Cancer. 2017;117:180–9.
doi: 10.1002/cncr.25542
Grubbs SS, Polite BN, Carney J Jr, et al. Eliminating racial disparities in colorectal cancer in the real world: it took a village. J Clin Oncol. 2013;31:1928–30.
doi: 10.1200/JCO.2012.47.8412
pubmed: 23589553
pmcid: 3661932
Kaleem T, Li Smith G, Miller R. Impact of care disparities in radiation oncology (Editorial). Adv Radiat Oncol. 2018;3:1–2.
doi: 10.1016/j.adro.2017.09.003
pubmed: 29556571
McClelland S, Page B, Jaboin J, et al. The pervasive crisis of diminishing radiation therapy access for vulnerable populations in the United States, part 1: African-American patients. Adv Radiat Oncol. 2017;2:523–31.
doi: 10.1016/j.adro.2017.07.002
pubmed: 29204518
pmcid: 5707425
McClelland S, Leberknight J, Guadagnolo B, et al. The pervasive crisis of diminishing radiation therapy access for vulnerable populations in the United States, part 2: American Indian patients. Adv Radiat Oncol. 2018;3:3–7.
doi: 10.1016/j.adro.2017.08.010
pubmed: 29556572
McClelland S, Perez C. The pervasive crisis of diminishing radiation therapy access for vulnerable populations in the United States—part 3: Hispanic-American patients. Adv Radiat Oncol. 2018;3:93–9.
doi: 10.1016/j.adro.2017.12.003
pubmed: 29904731
Wheeler SB, Carpenter WR, Peppercorn J, et al. Structural/organizational characteristics of health services partly explain racial variation in timeliness of radiation therapy among elderly breast cancer patients. Breast Cancer Res Treat. 2012;133:333–45.
doi: 10.1007/s10549-012-1955-2
pubmed: 22270934
pmcid: 5824428
Voti L, Richardson LC, Reis IM, et al. Treatment of local breast carcinoma in Florida: the role of the distance to radiation therapy facilities. Cancer. 2006;106:201–7.
doi: 10.1002/cncr.21557
pubmed: 16311987
Peipins LA, Graham S, Young R, et al. Racial disparities in travel time to radiotherapy facilities in the Atlanta metropolitan area. Soc Sci Med. 2013;89:32–8.
doi: 10.1016/j.socscimed.2013.04.018
pubmed: 23726213
pmcid: 5836478
Bickell NA, Shastri K, Fei K, et al. A tracking and feedback registry to reduce racial disparities in breast cancer care. J Natl Cancer Inst. 2008;100:1717–23.
doi: 10.1093/jnci/djn387
pubmed: 19033569
pmcid: 2727139
Du Xianglin L, Gor BJ. Racial disparities and trends in radiation therapy after breast-conserving surgery for early-stage breast cancer in women, 1992 to 2002. Ethn Dis. 2007;17:122–8.
pubmed: 17274221
Dragun AE, Huang B, Tucker TC, et al. Disparities in the application of adjuvant radiotherapy after breast-conserving surgery for early stage breast cancer: impact on overall survival. Cancer. 2011;117:2590–8.
doi: 10.1002/cncr.25821
pubmed: 21656737
Royak-Schaler R, Pelser C, Langenberg P, et al. Characteristics associated with the initiation of radiation therapy after breast-conserving surgery among African American and white women diagnosed with early-stage breast cancer in Maryland, 2000–2006. Ann Epidemiol. 2012;22:28–36.
doi: 10.1016/j.annepidem.2011.10.001
pubmed: 22037379
Yeboa DN, Xu X, Jones BA, Soulos P, et al. Trend in age and racial disparities in the receipt of postlumpectomy radiation therapy for stage I breast cancer: 2004–2009. Am J Clin Oncol. 2016;39:568–74.
doi: 10.1097/COC.0000000000000094
pubmed: 24879475
Martinez SR, Beal SH, Chen SL, et al. Disparities in the use of radiation therapy in patients with local-regionally advanced breast cancer. Int J Radiat Oncol Biol Phys. 2010;78:787–92.
doi: 10.1016/j.ijrobp.2009.08.080
pubmed: 20619550
pmcid: 2946458
Sail K, Franzini L, Lairson D, Du X. Differences in treatment and survival among African-American and Caucasian women with early stage operable breast cancer. Ethn Health. 2012;17:309–23.
doi: 10.1080/13557858.2011.628011
pubmed: 22066691
Obirieze AC, Moten A, Allen D, et al. African-American men with low-risk prostate cancer: modern treatment and outcome trends. J Racial Ethn Health Disparities. 2015;2:295–302.
doi: 10.1007/s40615-014-0071-x
pubmed: 26863460
Bradley CJ, Dahman B, Given CW. Treatment and survival differences in older Medicare patients with lung cancer as compared with those who are dually eligible for Medicare and Medicaid. J Clin Oncol. 2008;26:5067–73.
doi: 10.1200/JCO.2008.16.3071
pubmed: 18794546
pmcid: 2652096
Smith GL, Shih YC, Xu Y, et al. Racial disparities in the use of radiotherapy after breast-conserving surgery: a national Medicare study. Cancer. 2010;116:734–41.
doi: 10.1002/cncr.24741
pubmed: 20014181
Parise CA, Bauer KR, Caggiano V. Disparities in receipt of adjuvant radiation therapy after breast-conserving surgery among the cancer-reporting regions of California. Cancer. 2012;118:2516–24.
doi: 10.1002/cncr.26542
pubmed: 21918967
Abdollah F, Sammon JD, Majumder K, et al. Racial disparities in end-of-life care among patients with prostate cancer: a population-based study. J Natl Compr Canc Netw. 2015;13:1131–8.
doi: 10.6004/jnccn.2015.0138
pubmed: 26358797
Simpson DR, Martínez ME, Gupta S, et al. Racial disparity in consultation, treatment, and the impact on survival in metastatic colorectal cancer. J Natl Cancer Inst. 2013;105:1814–20.
doi: 10.1093/jnci/djt318
pubmed: 24231453
pmcid: 4383284
CMS: Standard Analytical Files (Medicare Claims) - LDS, 2021. https://www.cms.gov/Research-Statistics-Data-and-Systems/Files-for-Order/LimitedDataSets/StandardAnalyticalFiles
Centers for Medicare & Medicaid Services (CMS): Medicare program; specialty care models to improve quality of care and reduce expenditures. Final rule with comment period. Fed Regist. 2020; 85: 61114–381
Ohri N, Rapkin BD, Guha C, et al. Radiation therapy noncompliance and clinical outcomes in an urban academic cancer center. Int J Radiat Oncol Biol Phys. 2016;95:563–70.
doi: 10.1016/j.ijrobp.2016.01.043
pubmed: 27020104
Bese NS, Hendry J, Jeremic B. Effects of prolongation of overall treatment time due to unplanned interruptions during radiotherapy of different tumor sites and practical methods of compensation. Int J Radiat Oncol Biol Phys. 2007;68:654–61.
doi: 10.1016/j.ijrobp.2007.03.010
pubmed: 17467926
Petereit DG, Sarkaria JN, Chappell R, et al. The adverse effect of treatment prolongation in cervical carcinoma. Int J Radiat Oncol Biol Phys. 1995;32:1301–7.
doi: 10.1016/0360-3016(94)00635-X
pubmed: 7635769
Bilheimer LT, Sisk JE. Collecting adequate data on racial and ethnic disparities in health: the challenges continue. Health Aff. 2008;27:383–91.
doi: 10.1377/hlthaff.27.2.383
Ng JH, Ye F, Ward LM, et al. Data on race, ethnicity, and language largely incomplete for managed care plan members. Health Aff. 2017;36:548–52.
doi: 10.1377/hlthaff.2016.1044
Jarrin OF, Nyandege AN, Grafova IB, et al. Validity of race and ethnicity codes in Medicare administrative data compared with gold-standard self-reported race collected during routine home health care visits. Med Care. 2020;58:e1–8.
doi: 10.1097/MLR.0000000000001216
pubmed: 31688554
pmcid: 6904433
Eicheldinger C, Bonito A. More accurate racial and ethnic codes for Medicare administrative data. Health Care Financ Rev. 2008;29:27–42.
pubmed: 18567241
pmcid: 4195038
Waldo DR. Accuracy and bias of race/ethnicity codes in the Medicare enrollment database. Health Care Financ Rev. 2004;26:61–72.
pubmed: 25371985
pmcid: 4194866