Breast cancer patients in U.S. territories receive lower quality care

(Reuters Health) - Older women with breast cancer who live in United States territories are less likely than their peers in the continental U.S. to receive recommended care, a study suggests.

“These findings are particularly relevant now, when we are considering how to best help the communities in territories that have been ravaged by hurricanes, and how to rebuild the healthcare infrastructure,” Dr. Cary Gross of Yale School of Medicine in New Haven, Connecticut told Reuters Health in an email.

“We need to make it even better than it was - because even before the hurricanes, the quality of care in the territories was not equitable. We need to do better,” said Gross, who is the senior author of the study.

Home to almost five million people, the U.S. territories include American Samoa, the Commonwealth of the Northern Mariana Islands, Guam, the U.S. Virgin Islands, and the Commonwealth of Puerto Rico. While they do not share the same status as states, they are under the jurisdiction of the U.S. government.

Gross and colleagues mined data collected by the Centers for Medicare and Medicaid Services between 2008 and 2014 on women age 66 and older who were diagnosed with breast cancer and received surgical treatment.

Overall, roughly 570 study subjects were residents of the U.S. territories and 259,000 lived in the continental U.S., according to the report in Health Affairs.

The study looked at whether women underwent needle biopsy (as opposed to only surgical biopsy), how much time passed between the initial breast cancer diagnosis and treatment, and whether radiation therapy was prescribed in addition to breast-conserving surgery.

The study found that breast cancer patients in the territories were 24 percent less likely to receive needle biopsy and 34 percent less likely to receive radiation treatment, compared to patients in the continental U.S.

They were also significantly less likely to receive timely care: 45 percent less likely to receive surgical treatment within three months and 82 percent less likely to receive timely radiation therapy.

“The implication for these women is that they are at higher risk of recurrence due to delayed surgeries, delayed radiation, and in some cases no radiation even when indicated,” Dr. Ben Smith told Reuters Health in an email.

“Paradoxically, they are also over-treated in the sense that they are more likely to undergo open surgical biopsy as opposed to minimally invasive needle biopsy,” added Smith, an Associate Professor of Radiation Oncology and Health Services Research at The University of Texas MD Anderson Cancer Center in Houston who was not involved in the study.

The study has some limitations. For example, researchers did not have information on women’s cancer stage. Also, the small number of breast cancer cases in the territories didn’t allow for comparisons of care within and between the territories themselves.

Still, the authors believe, the “results likely underestimated the disparities between the territories and the continental U.S. in breast cancer care.”

They point out that Medicare payments to doctors are lower in the territories than in the states, and caps on federal spending further deplete financial resources. Previous studies have revealed disparities in care for other medical conditions in the U.S. territories.

“We still have a long way to go to ensure equitable breast cancer care for women who live in U.S. territories,” said Smith.

“Our findings that breast cancer care in the territories may be lower quality than in the rest of the U.S. is really a call to action,” said Gross in an email. “One can only hope that our policy makers are listening.”

SOURCE: Health Affairs, online March 8, 2018.