Demographic risk factors impacting timely radiation therapy completion after breast conserving surgery.

BACKGROUND: Radiotherapy completion (RTC) is critical to successful breast conserving treatment. Our aim was to identify patient groups at greatest risk of not achieving timely radiotherapy completion (TRTC) in an urban setting. METHODS: This observational cohort study used hospital registry data from 2004 to 2010 for female stage I and II breast conserving treatment patients to assess predictors of RTC and TRTC, defined as RTC of 35 to 49 days. RESULTS: Two hundred sixty-one patients were analyzed. There was no difference in mean days to RTC by ethnicity (black 46.8, white 46.4, Hispanic 48.1 days, P = .75) or total RTC (black 88.2%, white 97.9%, Hispanic 93.3%, P = .09). However, a substantial difference was seen in TRTC by ethnicity (black 51.8%, white 79.2%, Hispanic 57.8%, P = .03). Multivariate logistic regression analysis of failure to achieve TRTC found associations with black race (odds ratio [OR] 2.67), Medicare (OR 3.46), Medicaid (OR 2.19), and age less than 50 years (OR 4.13). CONCLUSIONS: This study demonstrates high overall percentage RTC but demonstrates disparities in TRTC. Those at greatest risk of unsuccessful TRTC were younger, Medicare or Medicaid insured, and black race.

Association of race and socioeconomic status and outcomes of patients with rectal cancer.

BACKGROUND: Few studies have evaluated disparities of race and socioeconomic status (SES) with outcomes in patients with rectal cancer. We hypothesize that disparities exist in the treatment and outcomes among patients with rectal cancer. METHODS: Medical records of all patients with rectal cancer treated from 2000 to 2009 at an NCI cancer center (Fox Chase Cancer Center) and an urban academic center (Temple University Hospital) were retrospectively reviewed from a prospectively maintained tumor registry database. SES was estimated using census data. Quartiles of income and education based on zip codes were calculated. Lowest vs other quartiles were compared. Clinicopathologic variables included: initial stage, chemotherapy refusal, sphincter preservation, and overall survival (OS). RESULTS: A total of 748 patients were included in the analysis (581 white, 135 black, 6 other, 26 unknown). No difference in race, SES, or insurance status was seen with regard to stage at presentation. Chemotherapy and radiation refusal was rare. After excluding stage IV patients; sphincter preservation was more common among those with higher income. Median OS for all stages was worse for nonwhite patients (31 vs 50 months, p < .001), and those with low income and education. OS disparities were most pronounced among nonwhite patients with advanced disease. Insurance was not associated with a survival difference. Age, stage, and race were independent predictors of survival. CONCLUSIONS: Disparity exists in outcomes of patients with rectal cancer. Nonwhite race is associated with worse OS, and lower SES is associated with lower OS and sphincter preservation among patients with rectal cancer.