Breast Carcinoma Treatment Received by Women with Disabilities Compared with Women without Disabilities

Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas 77046, USA.
Cancer (Impact Factor: 4.89). 03/2002; 94(5):1391-6. DOI: 10.1002/cncr.10369
Source: PubMed


Disability may make it difficult to lie flat or abduct the arm to deliver radiation therapy, imposing a high risk for radiation-induced side effects or difficulty in positioning patients for mammography. The goal of the current study was to determine the differences in treatment options experienced by women with physical disabilities compared with those without disabilities.
Chart review of 234 women who underwent surgery for breast carcinoma between June and September 1998 in a national comprehensive cancer center was conducted. Thirty-nine of the women had physical disabilities; the remaining 195 women were without disabilities. Hierarchical logistic regression was used to determine whether women with disabilities were less likely than women without disabilities to be treated with breast-conservation surgery (BCS) or neoadjuvant chemotherapy.
Women with disabilities underwent BCS 38% of the time, whereas women without disabilities underwent BCS 49% of the time. Neither the presence nor absence of disability (P = 0.146) nor patient age (P = 0.747) were found to be significant predictors of BCS. However, the disease stage at the time of the surgery was reported to be a significant predictor of BCS (P = 0.007). The group of patients with disabilities received neoadjuvant chemotherapy 13% of the time, whereas women without disabilities received it 29% of the time. Disability was not found to be a significant predictor of whether a patient received neoadjuvant chemotherapy. Using hierarchical logistic regression, patient age was found to be a significant predictor of neoadjuvant chemotherapy before the disease stage was entered into the regression equation. There were no data to support the hypothesis that breast carcinoma is at an advanced stage when diagnosed in women with disabilities.
These findings are clinically significant in that they indicate that women with disabilities are less likely to undergo BCS and are less likely to receive neoadjuvant chemotherapy compared with women without disabilities, but the difference did not reach statistical significance. To the authors' knowledge, there are no data to support the hypothesis that disabled women are diagnosed at a more advanced stage of disease compared with women without disabilities.

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Available from: Margaret A Nosek, Oct 14, 2014
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    • "Patient characteristics evaluated in the studies identified included age, race, SES/income, education, and language barriers (Table 1). Age was the most frequently considered characteristic, being discussed in 10 studies.14,15,17–20,22,26,28,30 Race was considered in five studies,12,18,25,26,29 SES/income in three,12,16,24 education in four,12,22,26,28 and language barriers in two.12,22 "
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    • "For whatever reason, persons with SSDI/Medicare are diagnosed with these four cancers at similar or earlier stages than other individuals . Our findings are consistent with those of Caban et al. (2002), who found that women with disabilities were diagnosed with breast cancer at similar stages than women without disabilities. However, studies suggest that physicians may not fully address wellness topics with some patients with disabilities (Chan et al. 1999; Iezzoni et al. 2000, 2001). "
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    ABSTRACT: This retrospective, cross-sectional, multiple cohort study of women with disabilities addresses two health-related areas in a nationally representative sample of women living in the community. Using data from the 1997-1998 National Health Interview Survey (NHIS), health risk behaviors and chronic conditions were examined for women with mild, moderate, and severe functional limitations, and their responses were compared to those of women who reported no limitations. Women with severe limitations evidenced the highest risk for heavy cigarette smoking. They were also more likely to meet the Body Mass Index criterion for obesity. Adverse health behaviors were strongly associated with the five potentially disabling chronic conditions that were studied.
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