A recent study found that breast cancer patients in early or middle adulthood with young children were less likely to receive radiation therapy after breast-conserving therapy.
The researchers believe that unique challenges arise because of outside factors such as time spent on childcare.
"Discuss your treatment concerns with a doctor if you have small children."
The lead author of this study was Ya-Chen Tina Shih, PhD, from the Section of Hospital Medicine in the Department of Medicine at the University of Chicago in Chicago, Illinois.
The study included 21, 008 women with invasive breast cancer who had breast-conserving surgery (BCS) between January 1, 2004 and December 31, 2009. All participants were between the ages of 20 and 64 years old, and had continuous insurance enrollment for the year before and year after surgery.
None of the participants had undergone a mastectomy (surgical removal of the breasts) within 12 months of BCS, radiation therapy (RT) before BCS, or had a history of breast cancer.
The researchers used MarketScan — a nationwide, employment-based database of medical and outpatient prescription drug claims for employees and their families — to determine if any of the participants had undergone RT within a year after BCS.
Data on participants' age, geographical location of living, and whether or not they were the primary person in their insurance plan was also taken from MarketScan.
Family types were categorized into four different categories:
• families with at least one child under the age of 7 years old
• families with no children under 7, but at least one child between 7 and 12 years old
• families with no children under 13, but at least one child between 13 and 17 years old
• families with either no children or children over the age of 17 years old
Then the researchers grouped each participant by the type of insurance plan they had. The two groups were:
- health maintenance organization (HMO) or preferred provider organization (PPO)
- all other plans
Lastly, geographic location of BCS was compared to the region in which each participant lived.
The findings showed that 18,120 participants (or 86 percent) had received RT within a year of BCS.
Ninety percent of the participants did not have any co-occurring conditions.
The researchers also found that 60 percent of the participants were primary holders of their insurance policy.
Four percent of the participants had at least one child younger than seven years old. Of this group, 81 percent had undergone RT.
It wad determined that the participants 50 years old and older were more likely to have undergone RT than women under 50 years old.
Compared to women under 50, the researchers found that participants who were 51 to 55 years old were 22 percent more likely to have had RT, participants between 56 and 60 years old were 38 percent more likely to have had RT, and those between the ages of 61 and 64 were 28 percent more likely to have had RT.
The findings revealed that a participant's odds of having RT were significantly lowered if they had a child that was less than seven years old.
The researchers determined that participants with children aged seven to 12 years old, participants with children between 13 and 17 years old, and patients with either no children or children 18 years old or older were 32 percent more likely, 41 percent more likely and 38 percent more likely to have undergone RT compared to participants with children under the age of 7.
In addition, the participants with either an HMO or PPO plan were 30 percent less likely to have received RT compared to participants with any other insurance plan.
Participants who traveled to another geographical region of the country for BCS were 28 percent less likely to have received RT versus patients who got BCS in the same region as where they lived.
For the participants who received BCS in an outpatient setting, there were 28 percent decreased odds of having received RT compared to the participants who recieved BCS in an inpatient setting.
Lastly, the researchers found that the participants who were the primary holders in their insurance plan were 20 percent more likely to have received RT, compared to the participants who were not the primary holder.
The findings showed that the association between young children and lower likelihood of having RT was only statistically significant in women between the ages of 20 and 50 years old.
The researchers suggested that younger cancer patients with young children face the most barriers in completing all recommended steps of breast cancer therapy.
The authors noted a few limitations.
First, data on race and ethnicity was included in the MarketScan. Second, the researchers did not know specific details of each participants' cancer. Third, some of the participants may not have had their children covered under their insurance plan.
"For breast cancer patients undergoing breast conserving therapy, the treatment recommended is lumpectomy (removal of the tumor) followed by a few weeks of daily radiation. This study is identifying a population who is having difficulty completing the required cancer treatment and might have and increased cancer relapse rate," said Subhakar "Sub" Mutyala, MD, Associate Director of the Baylor Scott & White Cancer Institute and Associate Professor at Texas A&M College of Medicine in Temple, Texas.
"This is important to know for patients because if you cannot complete the radiation treatment, breast conserving cancer treatment would not be adequate and mastectomy might be a better treatment option," Dr. Mutyala told dailyRx News.
This study was published online ahead-of-print on December 7 in the Journal of the National Cancer Institute.
The Agency for Healthcare Research and Quality, the University of Chicago Cancer Research Foundation Women's Board and the Cancer Prevention Research Institute of Texas provided funding.