DISPARITIES IN THE RECEIPT OF RADIATION THERAPY AMONG WOMEN UNDERGOING BREAST-CONSERVING SURGERY IN GEORGIA Öffentlichkeit

Abstract

DISPARITIES IN THE RECEIPT OF RADIATION THERAPY AMONG WOMEN

UNDERGOING BREAST CONSERVING THERAPY IN GEORGIA

Objectives: The goal of this study was to determine whether there were socioeconomic
disparities in the receipt of radiation therapy among women in Georgia who underwent
breast conserving surgery (BCS) from 2004-2008. Failure to receive recommended radiation
therapy following BCS results in greater risk of tumor recurrence and decreased survival.
Exploring disparities in the receipt of guideline concordant therapy among a
socioeconomically and racially diverse population of breast cancer patients will help to more
fully understand how to bridge the gaps that exist in the receipt of standard of care
treatment.
Methods: Using data from the Georgia Cancer Registry, all cases of breast cancer among
women in Georgia who underwent breast conserving surgery and met clinical guidelines for
radiation therapy were identified. Two measures of SES, derived from U.S. census tract
data, were utilized: percentage of persons living in poverty and a composite measure of
deprivation in Georgia. Covariates controlled for in multivariate logistic regression models
included race, rural-urban residence, marital status, age at diagnosis, year of diagnosis, stage,
estrogen receptor status, progesterone receptor status, primary site, and grade.
Results: In our study population, twenty percent of women did not receive the
recommended therapy. Women in Georgia residing in low socioeconomic status census
tracts have an increased odds of not receiving the standard of care radiation therapy even
after controlling for other study covariates, compared to women in high socioeconomic
status census tracts(OR 1.61, 95% CI 1.37-1.89 for poverty; OR 1.29, 95% CI 1.10-1.52 for
deprivation). This same association was not found among women in the mid-level SES
category.
Conclusions: This study has identified socioeconomic status as a risk factor for not
receiving of standard of care radiation therapy among women who have undergone breast
conserving surgery in Georgia. Women residing in lower SES tracts are at a greater risk of
not receiving standard of care radiation therapy following breast conserving surgery. Future
interventions in Georgia should be directed towards increasing access and health literacy to women residing in lower socioeconomic areas.

Table of Contents

Table of Contents
Background and Literature Review .................................................................................................... 1
Methods ............................................................................................................................................ 7
Study Population ........................................................................................................................... 7
Socioeconomic Status.................................................................................................................... 7
Covariate Definitions .................................................................................................................... 9
Statistical Analyses ...................................................................................................................... 10
Results ............................................................................................................................................ 12
Discussion ...................................................................................................................................... 16
Strengths and Weaknesses ........................................................................................................... 18
Future Directions ........................................................................................................................ 19
References ...................................................................................................................................... 20
Tables ............................................................................................................................................. 23
Figures ............................................................................................................................................ 31

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MSPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology
Stichwort	Georgia SES disparity radiation breast cancer
Committee Chair / Thesis Advisor	Ward, Kevin C, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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