Compliance with radiation therapy in breast cancer patients in Southeastern Kentucky.

Background: Nearly a quarter of Americans live in rural areas, which consistently report higher cancer mortality rates than urban and suburban areas. The worse outcome for cancer patients in these areas has been attributed in part to compliance with treatment recommendations. Southeastern Kentucky is a rural area with a low income population and barriers such as distance and lack of public transportation to access health care and compliance with treatment is a major concern. Methods: Data on patients with breast cancer treated with radiation therapy at Appalachian Regional Healthcare cancer center which serves the area of Southeastern Kentucky were collected. Age, economic status (measured by availability of medical insurance), distance of patient's residence from the hospital, were evaluated as potential predictors of compliance with recommendations to obtain radiation therapy. Data were analyzed with Fisher's exact test. Results: A total of 80 patients with breast cancer received adjuvant radiation treatment from 2008 to 2011. Of these 80 patients, 24 (30%) had Medicaid, 31 (39%) had Medicare, and 25 (31 %) had commercial health insurance. Only two (2.5%) patients did not complete treatment due to transportation. An additional 10 patients (13%) had treatment interruption due to weather, transportation or other financial reasons. In patients who completed treatment, a total of 2640 days of treatment were provided. A total of 55 (2.1 %) days of treatment were missed. Of the 10 patients who had interruption, 5 of them had Medicaid and the number of missed days by the Medicaid patients was (37/55), which is 67% of the total days missed. No statistically significant difference was detected in the number of patients missing treatment between Medicaid and other insurance types (p = 0.16). None of the factors evaluated predicted patient compliance, although a trend toward lower compliance was noted in patients who had Medicaid. Conclusion: Despite being a rural area with multiple barriers to access healthcare, the rate of full compliance (defined as completion of the entire course of radiation therapy) with adjuvant radiation therapy in breast cancer patients in Southeastern Kentucky was 97.5%, which is similar to the rates in clinical trials that generally exceed 90%. A trend toward lower compliance was noted in patients who had Medicaid although it was not statistically significant. [ABSTRACT FROM AUTHOR]