Early Stage Breast Cancer Treatments for Younger Medicare Beneficiaries with Different Disabilities

Authors

  • Lisa I. Iezzoni,

    1. Institute for Health Policy, Division of Medicine, Massachusetts General Hospital and Harvard Medical School, 50 Staniford St., Rm 901C, Boston, MA 02114,
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    • Address correspondence to Lisa I. Iezzoni, M.D., M.Sc., Institute for Health Policy, Division of Medicine, Massachusetts General Hospital and Harvard Medical School, 50 Staniford St., Rm 901C, Boston, MA 02114; e-mail: liezzoni@partners.org. Long H. Ngo, Ph.D., is with the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA. Donglin Li, M.D., M.P.H., is with the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA. Richard G. Roetzheim, M.D., M.P.S.H., is with the Department of Family Medicine, University of South Florida, Tampa, FL. Reed E. Drews, M.D., is with the Division of Hematology and Oncology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA. Ellen P. McCarthy, Ph.D., M.P.H., is with the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.

  • Long H. Ngo,

    1. Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA,
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  • Donglin Li,

    1. Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA,
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  • Richard G. Roetzheim,

    1. Department of Family Medicine, University of South Florida, Tampa, FL,
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  • Reed E. Drews,

    1. Division of Hematology and Oncology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
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  • Ellen P. McCarthy

    1. Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
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Abstract

Objective. To explore how underlying disability affects treatments and outcomes of disabled women with breast cancer.

Data Sources. Surveillance, Epidemiology, and End Results program data, linked with Medicare files and Social Security Administration disability group.

Study Design. Ninety thousand two hundred and forty-three incident cases of early-stage breast cancer under age 65; adjusted relative risks and hazards ratios examined treatments and survival, respectively, for women in four disability groups compared with nondisabled women.

Principal Findings. Demographic characteristics, treatments, and survival varied among four disability groups. Compared with nondisabled women, those with mental disorders and neurological conditions had significantly lower adjusted rates of breast conserving surgery and radiation therapy. Survival outcomes also varied by disability type.

Conclusions. Compared with nondisabled women, certain subgroups of women with disabilities are especially likely to experience disparities in care for breast cancer.

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