Having a disability may impact breast cancer care

NEW YORK (Reuters Health) - After treatment for early breast cancer, the death rate of women with disabilities is higher than that of other women without disabilities, according to a report published this week.

This may be due, at least in part, to their receiving care that fails to meet recommendations by the National Institute of Health and the National Comprehensive Cancer Network.

Lead author Dr. Ellen P McCarthy, from Harvard Medical School in Boston, and her colleagues point out that little is known about this subset of patients, because they are almost always excluded from clinical trials.

In what they believe to be the only such study, McCarthy's group obtained data from the Surveillance, Epidemiology, and End Results (SEER) Program, which is linked with a Medicare database, regarding women diagnosed with stage I to IIIA breast cancer. Eligibility for Social Security Disability Insurance and Medicare was used to identify women with disabilities.

The authors estimated relative risks (RR) and hazard ratios (HR) after adjusting for demographic and tumor characteristics for a cohort of about 100,000 women ages 21 to 64 years diagnosed with a first breast cancer between 1988 and 1999, of whom 2800 were disabled.

McCarthy and her team found that tumors did not differ significantly between the disabled and non-disabled women with regard to stage at diagnosis, size or histology.

The researchers found that women with disabilities were less likely to undergo breast-conserving surgery, and those who did have this procedure were less likely to have undergone axillary lymph node dissection or radiation therapy.

They were also more likely to have died by 2001.

The authors advise that "the higher mortality rates observed in our study should be interpreted with caution," because the data did not include information about underlying disabilities or treatment with hormones or adjuvant chemotherapy.

There are many issues to address when considering treatment for patients with disabling impairments. For example, the researchers point out that total mastectomy or extensive dissection of the lymph nodes could hamper a disabled patient's mobility if they lose strength in their arms and upper bodies required to use wheelchairs or walkers.

A physical impairment may prevent them from receiving radiation therapy, because they can't lie still or adequately lift their arm. Or they simply may not have reliable transportation to complete a rigorous course of radiotherapy.

Nevertheless, McCarthy and her associates recommend further research to find the reasons why these women receive less than the best treatment. For instance there may be poor communication between the physician and the patient, or the pragmatic difficulties such as a lack of transportation.

SOURCE: Annals of Internal Medicine, November 7, 2006.