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Zhang Y, Yao W, Zhou J, Zhang L, Chen Y, Li F, Gu H, Wang H. Impact of surgical compliance on survival prognosis of patients with ovarian cancer and associated influencing factors: A propensity score matching analysis of the SEER database. Heliyon 2024; 10:e33639. [PMID: 39040330 PMCID: PMC11261776 DOI: 10.1016/j.heliyon.2024.e33639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 06/24/2024] [Accepted: 06/25/2024] [Indexed: 07/24/2024] Open
Abstract
Purpose To evaluate the impact of surgical compliance on overall survival (OS) and cancer-specific survival (CSS) in ovarian cancer patients and identify factors influencing surgical compliance. Materials and methods Data from patients with ovarian cancer in the SEER database (2004-2015) were analyzed to compare the characteristics of patients with high and low surgical compliance. Kaplan-Meier curves and Cox regression models were used to assess the impact of surgical compliance on survival outcomes. Nomograms incorporating surgical compliance and independent prognostic factors were constructed to predict OS and CSS and were validated using internal validation sets. Predictive accuracy was evaluated using Harrell's concordance index (C-index), decision curve analysis (DCA), receiver operating characteristic (ROC) curves, and calibration plots. Binary logistic regression analysis identified factors significantly affecting surgical compliance, and propensity score matching (PSM) was used to adjust for confounders. Results Among the 41,859 patients, 783 (1.87 %) demonstrated poor surgical compliance, while 41,076 (98.13 %) exhibited good compliance. Surgical compliance has emerged as an independent prognostic indicator for ovarian cancer. Patients with high compliance had significantly better OS and CSS rates (P < 0.0001). The prognostic models were internally validated and showed strong discriminative and calibration capabilities. Factors affecting compliance included older age, advanced pathological stage, metastasis, elevated CA-125 levels, and lower income. After PSM, Kaplan-Meier analysis revealed significantly improved survival in patients with good compliance (P < 0.0001). Conclusion Surgical compliance is a pivotal and independent predictor of overall and cancer-specific survival in patients undergoing OC. Factors contributing to lower surgical compliance include advanced age, later tumor stage, metastatic spread, elevated CA-125 levels, and reduced family income.
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Affiliation(s)
- Yanhua Zhang
- Department of Obstetrics and Gynecology, Binhai County People's Hospital, Yancheng, 224500, Jiangsu, China
| | - Wenlei Yao
- Department of Obstetrics and Gynecology, Binhai County People's Hospital, Yancheng, 224500, Jiangsu, China
| | - Jianbo Zhou
- Department of Obstetrics and Gynecology, Binhai County People's Hospital, Yancheng, 224500, Jiangsu, China
| | - Lingyan Zhang
- Department of Obstetrics and Gynecology, Binhai County People's Hospital, Yancheng, 224500, Jiangsu, China
| | - Yanhong Chen
- Department of Obstetrics and Gynecology, Binhai County People's Hospital, Yancheng, 224500, Jiangsu, China
| | - Fangfang Li
- Department of Oncology, Binhai County People's Hospital, Yancheng, 224500, Jiangsu, China
| | - Haidong Gu
- Department of Anesthetic, Binhai County People's Hospital, Yancheng, 224500, Jiangsu, China
| | - Hongyou Wang
- Department of Obstetrics and Gynecology, Binhai County People's Hospital, Yancheng, 224500, Jiangsu, China
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2
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Shifman HP, Huang CY, Beck AF, Bucuvalas J, Perito ER, Hsu EK, Ebel NH, Lai JC, Wadhwani SI. Association of state Medicaid expansion policies with pediatric liver transplant outcomes. Am J Transplant 2024; 24:239-249. [PMID: 37776976 PMCID: PMC10843745 DOI: 10.1016/j.ajt.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 08/22/2023] [Accepted: 09/14/2023] [Indexed: 10/02/2023]
Abstract
Children from minoritized/socioeconomically deprived backgrounds suffer disproportionately high rates of uninsurance and graft failure/death after liver transplant. Medicaid expansion was developed to expand access to public insurance. Our objective was to characterize the impact of Medicaid expansion policies on long-term graft/patient survival after pediatric liver transplantation. All pediatric patients (<19 years) who received a liver transplant between January 1, 2005, and December 31, 2020 in the US were identified in the Scientific Registry of Transplant Recipients (N = 8489). Medicaid expansion was modeled as a time-varying exposure based on transplant and expansion dates. We used Cox proportional hazards models to evaluate the impact of Medicaid expansion on a composite outcome of graft failure/death over 10 years. As a sensitivity analysis, we conducted an intention-to-treat analysis from time of waitlisting to death (N = 1 1901). In multivariable analysis, Medicaid expansion was associated with a 30% decreased hazard of graft failure/death (hazard ratio, 0.70; 95% confidence interval, 0.62, 0.79; P < .001) after adjusting for Black race, public insurance, neighborhood deprivation, and living in a primary care shortage area. In intention-to-treat analyses, Medicaid expansion was associated with a 72% decreased hazard of patient death (hazard ratio, 0.28; 95% confidence interval, 0.23-0.35; P < .001). Policies that enable broader health insurance access may help improve outcomes and reduce disparities for children undergoing liver transplantation.
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Affiliation(s)
- Holly Payton Shifman
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Chiung-Yu Huang
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Andrew F Beck
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - John Bucuvalas
- Division of Pediatric Hepatology, Department of Pediatrics Icahn School of Medicine at Mount Sinai, New York, New York, USA; Division of Pediatric Hepatology, Department of Pediatrics, Kravis Children's Hospital, New York, New York, USA
| | - Emily R Perito
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Evelyn K Hsu
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Noelle H Ebel
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children's Hospital, Stanford, California, USA
| | - Jennifer C Lai
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Sharad I Wadhwani
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA.
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3
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Barnes JM, Neff C, Han X, Kruchko C, Barnholtz-Sloan JS, Ostrom QT, Johnson KJ. The association of Medicaid expansion and pediatric cancer overall survival. J Natl Cancer Inst 2023; 115:749-752. [PMID: 36782354 PMCID: PMC10248835 DOI: 10.1093/jnci/djad024] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 01/04/2023] [Accepted: 01/28/2023] [Indexed: 02/15/2023] Open
Abstract
Medicaid eligibility expansion, though not directly applicable to children, has been associated with improved access to care in children with cancer, but associations with overall survival are unknown. Data for children ages 0 to 14 years diagnosed with cancer from 2011 to 2018 were queried from central cancer registries data covering cancer diagnoses from 40 states as part of the Centers for Disease Control and Prevention's National Program of Cancer Registries. Difference-in-differences analyses were used to compare changes in 2-year survival from 2011-2013 to 2015-2018 in Medicaid expansion relative to nonexpansion states. In adjusted analyses, there was a 1.50 percentage point (95% confidence interval = 0.37 to 2.64) increase in 2-year overall survival after 2014 in expansion relative to nonexpansion states, particularly for those living in the lowest county income quartile (difference-in-differences = 5.12 percentage point, 95% confidence interval = 2.59 to 7.65). Medicaid expansion may improve cancer outcomes for children with cancer.
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Affiliation(s)
- Justin M Barnes
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Corey Neff
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA
| | - Xuesong Han
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, GA, USA
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA
| | - Jill S Barnholtz-Sloan
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA
- Center for Biomedical Informatics & Information Technology and Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Quinn T Ostrom
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA
- The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
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4
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Heller RE, Joshi A, Sircar R, Hayatghaibi S. Medicaid and the Children's Health Insurance Program: an overview for the pediatric radiologist. Pediatr Radiol 2023; 53:1179-1187. [PMID: 36879048 PMCID: PMC9988602 DOI: 10.1007/s00247-023-05640-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/20/2023] [Accepted: 02/23/2023] [Indexed: 03/08/2023]
Abstract
In terms of number of beneficiaries, Medicaid is the single largest health insurance program in the US. Along with the Children's Health Insurance Program (CHIP), Medicaid covers nearly half of all births and provides health insurance to nearly half of the children in the country. This article provides a broad introduction to Medicaid and CHIP for the pediatric radiologist with a special focus on topics relevant to pediatric imaging and population health. This includes an overview of Medicaid's structure and eligibility criteria and how it differs from Medicare. The paper examines the means-tested programs within the context of pediatric radiology, reviewing pertinent topics such as the rise of Medicaid managed care plans, Medicaid expansion, the effects of Medicaid on child health, and COVID-19. Beyond the basics of benefits coverage, pediatric radiologists should understand how Medicaid and CHIP financing and reimbursement affect the ability of pediatric practices, radiology groups, and hospitals to provide services for children in a sustainable manner. The paper concludes with an analysis of future opportunities for Medicaid and CHIP.
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Affiliation(s)
- Richard E Heller
- Radiology Partners, 2330 Utah Avenue, Suite 200, El Segundo, CA, 90245, USA.
| | - Aparna Joshi
- Section of Pediatric Radiology, University of Michigan C.S. Mott Children's Hospital, 1540 E. Hospital Dr., SPC 4252, Ann Arbor, MI, 48109-4252, USA
| | - Robin Sircar
- Advocate Children's Hospital, 1775 Dempster Street, Park Ridge, IL, 60068, USA
| | - Shireen Hayatghaibi
- Department of Radiology, Cincinnati Children's Hospital Medical Center at University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
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5
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Ji X, Hu X, Castellino SM, Mertens AC, Yabroff KR, Han X. OUP accepted manuscript. JNCI Cancer Spectr 2022; 6:6522127. [PMID: 35699500 PMCID: PMC8877169 DOI: 10.1093/jncics/pkac006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/29/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
Despite advances toward universal health insurance coverage for children, coverage gaps remain. Using a nationwide sample of pediatric and adolescent cancer patients from the National Cancer Database, we examined effects of the Affordable Care Act (ACA) implementation in 2014 with multinomial logistic regressions to evaluate insurance changes between 2010-2013 (pre-ACA) and 2014-2017 (post-ACA) in patients aged younger than 18 years (n = 63 377). All statistical tests were 2-sided. Following the ACA, the overall percentage of Medicaid and Children’s Health Insurance Program–covered patients increased (from 35.1% to 36.9%; adjusted absolute percentage change [APC] = 2.01 percentage points [ppt], 95% confidence interval [CI] = 1.31 to 2.71; P < .001), partly offset by declined percentage of privately insured (from 62.7% to 61.2%; adjusted APC = −1.67 ppt, 95% CI = −2.37 to −0.97; P < .001), leading to a reduction by 15% in uninsured status (from 2.2% to 1.9%; adjusted APC = −0.34 ppt, 95% CI = −0.56 to −0.12 ppt; P = .003). The largest declines in uninsured status were observed among Hispanic patients (by 23%; adjusted APC = −0.95 ppt, 95% CI = −1.67 to −0.23 ppt; P = .009) and patients residing in low-income areas (by 35%; adjusted APC = −1.22 ppt, 95% CI = −2.22 to −0.21 ppt; P = .02). We showed nationwide insurance gains among pediatric and adolescent cancer patients following ACA implementation, with greater gains in racial and ethnic minorities and those living in low-income areas.
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Affiliation(s)
- Xu Ji
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Aflac Cancer & Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA, USA
- Correspondence to: Xu Ji, PhD, Department of Pediatrics, Emory School of Medicine, Aflac Cancer & Blood Disorders Center, Children’s Healthcare of Atlanta, 2015 Uppergate Dr, Atlanta, GA 30322, USA (e-mail: )
| | - Xin Hu
- Department of Health Policy and Management, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Sharon M Castellino
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Aflac Cancer & Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Ann C Mertens
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Aflac Cancer & Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA, USA
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
| | - Xuesong Han
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
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6
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Ji X, Castellino SM, Mertens AC, Zhao J, Nogueira L, Jemal A, Yabroff KR, Han X. Association of Medicaid Expansion With Cancer Stage and Disparities in Newly Diagnosed Young Adults. J Natl Cancer Inst 2021; 113:1723-1732. [PMID: 34021352 PMCID: PMC9989840 DOI: 10.1093/jnci/djab105] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 03/22/2021] [Accepted: 05/19/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Young adults (YAs) experience higher uninsurance rates and more advanced stage at cancer diagnosis than older counterparts. We examined the association of the Affordable Care Act Medicaid expansion with insurance coverage and stage at diagnosis among YAs newly diagnosed with cancer. METHODS Using the National Cancer Database, we identified 309 413 YAs aged 18-39 years who received a first cancer diagnosis in 2011-2016. Outcomes included percentages of YAs without health insurance at diagnosis, with stage I (early-stage) diagnoses, and with stage IV (advanced-stage) diagnoses. We conducted difference-in-difference (DD) analyses to examine outcomes before and after states implemented Medicaid expansion compared with nonexpansion states. All statistical tests were 2-sided. RESULTS The percentage of uninsured YAs decreased more in expansion than nonexpansion states (adjusted DD = -1.0 percentage points [ppt], 95% confidence interval [CI] = -1.4 to -0.7 ppt, P < .001). The overall percentage of stage I diagnoses increased (adjusted DD = 1.4 ppt, 95% CI = 0.6 to 2.2 ppt, P < .001) in expansion compared with nonexpansion states, with greater improvement among YAs in rural areas (adjusted DD = 7.2 ppt, 95% CI = 0.2 to 14.3 ppt, P = .045) than metropolitan areas (adjusted DD = 1.3 ppt, 95% CI = 0.4 to 2.2 ppt, P = .004) and among non-Hispanic Black patients (adjusted DD = 2.2 ppt, 95% CI = -0.03 to 4.4 ppt, P = .05) than non-Hispanic White patients (adjusted DD = 1.4 ppt, 95% CI = 0.4 to 2.3 ppt, P = .008). Despite the non-statistically significant change in stage IV diagnoses overall, the percentage declined more (adjusted DD = -1.2 ppt, 95% CI = -2.2 to -0.2 ppt, P = .02) among melanoma patients in expansion relative to nonexpansion states. CONCLUSIONS We provide the first evidence, to our knowledge, on the association of Medicaid expansion with shifts to early-stage cancer at diagnosis and a narrowing of rural-urban and Black-White disparities in YA cancer patients.
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Affiliation(s)
- Xu Ji
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Sharon M Castellino
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Ann C Mertens
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA.,Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Jingxuan Zhao
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
| | - Leticia Nogueira
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
| | - K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
| | - Xuesong Han
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
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7
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Ermer T, Walters SL, Canavan ME, Salazar MC, Li AX, Doonan M, Boffa DJ. Understanding the Implications of Medicaid Expansion for Cancer Care in the US: A Review. JAMA Oncol 2021; 8:139-148. [PMID: 34762101 DOI: 10.1001/jamaoncol.2021.4323] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance Insurance status has been linked to important differences in cancer treatment and outcomes in the US. With more than 15 million individuals gaining health insurance through Medicaid expansion, there is an increasing need to understand the implications of this policy within the US cancer population. This review provides an overview of the fundamental principles and nuances of Medicaid expansion, as well as the implications for cancer care. Observations The Patient Protection and Affordable Care Act presented states with an option to expand Medicaid coverage by broadening the eligibility criteria (eg, raising the eligible income level). During the past 10 years, Medicaid expansion has been credited with a 30% reduction in the population of uninsured individuals in the US. Such a significant change in the insurance profile could have important implications for the 1.7 million patients diagnosed with cancer each year, the oncology teams that care for them, and policy makers. However, several factors may complicate efforts to characterize the effect of Medicaid expansion on the US cancer population. Most notably, there is considerable variation among states in terms of whether Medicaid expansion took place, when expansion occurred, eligibility criteria for Medicaid, and coverage types that Medicaid provides. In addition, economic and health policy factors may be intertwined with factors associated with Medicaid expansion. Finally, variability in the manner in which cancer care has been captured and depicted in large databases could affect the interpretation of findings associated with expansion. Conclusions and Relevance The expansion of Medicaid was a historic public policy initiative. To fully leverage this policy to improve oncological care and to maximize learning for subsequent policies, it is critical to understand the effect of Medicaid expansion. This review aims to better prepare investigators and their audiences to fully understand the implications of this important health policy initiative.
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Affiliation(s)
- Theresa Ermer
- Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.,London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom.,Section of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Samantha L Walters
- Section of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Maureen E Canavan
- Section of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.,Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Michelle C Salazar
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.,National Clinician Scholars Program, Yale University School of Medicine, New Haven, Connecticut
| | - Andrew X Li
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Michael Doonan
- The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Daniel J Boffa
- Section of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
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8
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Mun S, Wang R, Ma X, Ananth P. Sociodemographic and hospital-based predictors of intense end-of-life care among children, adolescents, and young adults with hematologic malignancies. Cancer 2021; 127:3817-3824. [PMID: 34185881 PMCID: PMC8478813 DOI: 10.1002/cncr.33764] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/07/2021] [Accepted: 04/26/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Children, adolescents, and young adults with hematologic malignancies tend to receive high-intensity end-of-life care (HI-EOLC), but sociodemographic and hospital-based predictors of HI-EOLC remain unclear. METHODS The authors conducted a population-based, retrospective cohort study with the Premier Healthcare Database. They identified individuals with hematologic malignancies who were 0 to 39 years old at death and died between 2010 and 2017. HI-EOLC was defined as experiencing 2 or more of the following: cardiopulmonary resuscitation, intravenous chemotherapy, hemodialysis, mechanical ventilation, tracheostomy placement, or an emergency department visit within the last 30 days of life and death in the intensive care unit. Multivariable logistic regression models were constructed to identify patient sociodemographic and hospital characteristics associated with HI-EOLC. RESULTS Among 1454 decedents, more than half (55%) experienced HI-EOLC. In multivariable models, patients treated in medium (adjusted odds ratio [aOR], 1.63; 95% confidence interval [CI], 1.07-2.50) or large hospitals (aOR, 2.21; 95% CI, 1.45-3.39), insured by Medicaid (aOR, 1.40 ; 95% CI, 1.09-2.06), or receiving cancer-directed treatment in the Northeast (aOR, 1.50; 95% CI, 1.05-2.15) were more likely to receive HI-EOLC. CONCLUSIONS A majority of children, adolescents, and young adults with hematologic malignancies experienced HI-EOLC, and the likelihood of HI-EOLC was influenced by the hospital size, type of insurance, and geographic region. Further research is needed to determine how to mitigate these risks.
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Affiliation(s)
- Sophia Mun
- Yale Cancer Outcomes, Public Policy, and Effectiveness
Research (COPPER) Center, New Haven, CT
| | - Rong Wang
- Yale Cancer Outcomes, Public Policy, and Effectiveness
Research (COPPER) Center, New Haven, CT
- Department of Chronic Disease Epidemiology, Yale School of
Public Health, New Haven, CT
| | - Xiaomei Ma
- Yale Cancer Outcomes, Public Policy, and Effectiveness
Research (COPPER) Center, New Haven, CT
- Department of Chronic Disease Epidemiology, Yale School of
Public Health, New Haven, CT
| | - Prasanna Ananth
- Yale Cancer Outcomes, Public Policy, and Effectiveness
Research (COPPER) Center, New Haven, CT
- Department of Pediatrics, Yale School of Medicine, New
Haven, CT
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9
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Cooper SH, Phipps EJ, Lawson D, Meier ER. How we coordinate care for uninsured children with nonmalignant hematologic disorders. Pediatr Blood Cancer 2021; 68:e29103. [PMID: 34125474 DOI: 10.1002/pbc.29103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 11/12/2022]
Abstract
Providing medical care for uninsured children with nonmalignant hematologic diagnoses presents unique challenges to medical providers and multidisciplinary staff. Financial and psychosocial stressors can hinder optimal care of the uninsured child. Maximizing coverage of medical costs through patient enrollment in state and charity care programs and capitalizing upon community partnerships can help providers achieve comprehensive care for these children. Collaboration between primary care providers, subspecialists, and multidisciplinary teams can be optimized to facilitate provision of hematology care for uninsured children. We detail our experience in establishing these collaborations to improve access to subspecialty care for children with nonmalignant hematologic disorders.
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Affiliation(s)
- Sarah Hall Cooper
- Indiana Hemophilia and Thrombosis Center, Indianapolis, Indiana, USA
| | - Erin Jane Phipps
- Eskenazi Health/Indiana University Health, Indianapolis, Indiana, USA
| | - DeAuntae Lawson
- Indiana Hemophilia and Thrombosis Center, Indianapolis, Indiana, USA
| | - Emily Riehm Meier
- Indiana Hemophilia and Thrombosis Center, Indianapolis, Indiana, USA
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10
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Vasta LM, Zanetti RC, Anderson AB, Zhu K, Potter BK, Park AB, Lin J, Shriver CD, Warwick AB. Survival in Pediatric, Adolescent, and Young Adult Patients With Sarcoma in the Military Health System: Comparison With the SEER Population. J Pediatr Hematol Oncol 2021; 43:e832-e840. [PMID: 34397617 DOI: 10.1097/mph.0000000000002188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 03/01/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND We sought to compare survival outcomes of sarcomas in the pediatric and adolescent/young adult populations with universal care access in the Military Health System (MHS) to those from the United States general population. METHODS We compared data from the Department of Defense's (DoD) Automated Central Tumor Registry (ACTUR) and the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results (SEER) program on the overall survival of patients 24 years or younger with histologically or microscopically confirmed sarcoma between diagnosed between January 1, 1987, and December 31, 2013. The Kaplan-Meier survival curves were used to compare survival between the 2 patient populations. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) comparing ACTUR relative to SEER. RESULTS The final analysis included 309 and 1236 bone sarcoma cases and 465 and 1860 soft tissue sarcoma cases from ACTUR and SEER, respectively. Cox proportional hazards analysis showed soft tissue sarcoma patients in ACTUR had significantly better overall (HR=0.73, 95% CI=0.55-0.98) and 5-year overall (HR=0.63, 95% CI=0.46-0.86) survival compared with SEER patients, but no significant difference in overall or 5-year overall survival between ACTUR and SEER patients with bone sarcoma. CONCLUSION Survival data from the ACTUR database demonstrated significantly improved overall survival for soft tissue sarcomas and equivalent survival in bone sarcomas compared with that reported by SEER.
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Affiliation(s)
- Lauren M Vasta
- Departments of Pediatrics (Hematology and Oncology)
- National Capital Consortium, Walter Reed National Military Medical Center
| | - Richard C Zanetti
- Departments of Pediatrics (Hematology and Oncology)
- National Capital Consortium, Walter Reed National Military Medical Center
| | | | - Kangmin Zhu
- John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center
- Department of Surgery, Uniformed Services University of the Health Sciences
- Henry M. Jackson Foundation for the Advancement of Military Medicine
- Departments of Preventative Medicine and Biostatistics
| | | | - Amie B Park
- John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center
- Henry M. Jackson Foundation for the Advancement of Military Medicine
| | - Jie Lin
- John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center
- Department of Surgery, Uniformed Services University of the Health Sciences
- Henry M. Jackson Foundation for the Advancement of Military Medicine
| | - Craig D Shriver
- John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center
- Department of Surgery, Uniformed Services University of the Health Sciences
| | - Anne B Warwick
- Departments of Pediatrics (Hematology and Oncology)
- Pediatrics, Uniformed Services University, Bethesda, MD
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Galbraith AA, Carroll AE. Children's Health Is Too Often Ignored in Elections-Here Is Evidence to Help Change That. JAMA Pediatr 2020; 174:1026-1028. [PMID: 33016986 DOI: 10.1001/jamapediatrics.2020.3970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Alison A Galbraith
- Center for Healthcare Research in Pediatrics, Harvard Pilgrim Health Care Institute, Department of Population Medicine, Harvard Medical School, Boston, Massachusetts.,Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts.,Associate Editor, JAMA Pediatrics
| | - Aaron E Carroll
- Indiana University School of Medicine, Center for Pediatric and Adolescent Comparative Effectiveness Research, Indianapolis, Indiana.,Web and Social Media Editor, JAMA Pediatrics
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Gadkaree SK, McCarty JC, Feng AL, Siu JM, Burks CA, Deschler DG, Richmon JD, Varvares MA, Bergmark RW. Role of physician density in predicting stage and survival for head and neck squamous cell carcinoma. Head Neck 2020; 43:438-448. [PMID: 33015935 DOI: 10.1002/hed.26495] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/17/2020] [Accepted: 09/22/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Identifying and linking barriers to access to head and neck cancer care, specifically provider density, to stage of diagnosis and survival outcomes is important to serve as a foundation for policy interventions. METHODS Retrospective cohort study using patients with head and neck squamous cell (HNSCC) in the Surveillance, Epidemiology, and End Results (SEER) database from 2007 to 2016 and Area Resource File. Primary outcomes included stage of presentation and cancer-specific 5-year survival and relation to provider density. RESULTS The initial cohort consisted of 18 342 patients with oral cavity, 21 809 oropharyngeal, 15 860 laryngeal, and 2887 patients with hypopharyngeal malignancy. Non-Hispanic Black race and being uninsured increased the odds of presenting with advanced stage HNSCC and increased hazard of death. There was no significant and consistent association identified between Health Service Areas provider density and advanced stage at diagnosis or cancer-specific 5-year mortality. CONCLUSIONS Provider density of otolaryngologists and primary care physicians and dentists was not significantly associated with stage of presentation or cancer-specific survival for HNSCC while race and insurance status remained independent predictors for worse outcomes.
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Affiliation(s)
- Shekhar K Gadkaree
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Justin C McCarty
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Allen L Feng
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jennifer M Siu
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Otolaryngology, University of Toronto, Toronto, Ontario, USA
| | - Ciersten A Burks
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Daniel G Deschler
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jeremy D Richmon
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mark A Varvares
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Regan W Bergmark
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Buntin MB. Cancer, Coverage, and COVID-19. JAMA HEALTH FORUM 2020; 1:e200796. [DOI: 10.1001/jamahealthforum.2020.0796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Melinda B. Buntin
- Deputy Editor, JAMA Health Forum
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
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