Health system correlates of receipt of radiation therapy after breast-conserving surgery: a study of low-income Medicaid-enrolled women.

OBJECTIVE: To describe patient and healthcare system correlates of receipt of recommended care in North Carolina (NC) as indicated by receipt of adjuvant radiation therapy (RT) after breast-conserving surgery (BCS). STUDY
DESIGN: Retrospective cohort study.
METHODS: Subjects were 344 women diagnosed as having primary breast cancer in 1998 and 1999, who were classified as being alive at least 12 months after treatment with BCS. Medicaid claims were used to supplement central cancer registry (CCR) data about adjuvant RT, and hospital medical record verification was performed when no RT was documented. Health system characteristics (size and volume) were obtained from existing databases.
RESULTS: Of 344 NC women enrolled in Medicaid and treated with BCS, one third did not receive RT. The following patient and health system characteristics were associated with lack of receipt of adjuvant RT after BCS: older age (>or=65 years), residing in a low-population density county, receiving BCS at a smaller hospital, and living in a county classified as a whole-county specialist scarcity area.
CONCLUSIONS: Some low-income women do not access RT following BCS, placing them at risk for worse outcomes than those associated with standard mastectomy. We identify geographic isolation and scarcity of healthcare specialists as possible leverage points for interventions.