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Breast Cancer at Women with Disabilities
Disabled woman are 20 percent less
likely to receive breast-conserving © nci
Among women receiving treatment for early-stage breast cancer, patients with disabilities had higher breast cancer mortality rates and were less likely than other women to receive standard treatment following breast-conserving surgery, according to a study in the Nov. 7 issue of the Annals of Internal Medicine.
Led by researchers at Beth Israel Deaconess Medical Center (BIDMC), the findings represent the first and largest population-based study to look at cancer treatment for patients with disabilities.
"Because clinical trials typically exclude this population, there is little scientific evidence available to guide doctors in their treatment decisions,” explains the study's lead author Ellen McCarthy, PhD, MPH, of the Division of General Medicine and Primary Care at BIDMC and Assistant Professor of Medicine at Harvard Medical School (HMS). "Consequently, very little is known about cancer treatments for individuals with disabilities.”
There are two accepted therapeutic options for early stage breast cancer: mastectomy (removal of the entire breast) and breast-conserving surgery (removal of only the cancer) combined with auxiliary lymph node dissection and radiation therapy. In 1990, the National Institutes of Health (NIH) deemed both treatments equally effective with regard to survival and recurrence of cancer.
However, as the authors describe in their article, "Despite this, studies have repeatedly found that many women with traits that can suggest a social disadvantage - including older age, race or ethnicity, low socioeconomic status, rural residence and lack of health insurance - do not receive breast-conserving surgery.”
Noting that women with disabilities who develop early-stage breast cancer are another "potentially vulnerable group,” McCarthy and her co-authors set out to compare the likelihood of receiving initial treatment for early-stage breast cancer between women with and without disabilities, and their survival following diagnosis. They also examined the association between initial treatment and survival in the two groups of women.
After adjusting for demographic and tumour characteristics, the researchers' final analysis found that the women with disabilities were 20 percent less likely to receive breast-conserving surgery compared with women without disabilities. Furthermore, the women with disabilities who did receive breast-conserving surgery were 19 percent less likely to receive lymph node dissection and 17 percent less likely to receive radiation therapy following their surgery - both considered part of the standard treatment protocol - than were the other women.
The findings also showed that women with disabilities had a 29 percent higher risk of dying from their breast cancer but, says McCarthy, the differences in initial treatment did not explain the survival disadvantage among women with disabilities.
REHACARE.de; Source: Newswise