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Chen YJ, Princic N, Winer I, Richmond C, Williams J, Thavamani A, Levinthal DJ, Venkatesan T. Epidemiology, Comorbidities, and Treatment of Cyclic Vomiting Syndrome in the United States. Am J Gastroenterol 2024; 119:965-976. [PMID: 38088366 PMCID: PMC11062608 DOI: 10.14309/ajg.0000000000002628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 12/06/2023] [Indexed: 01/17/2024]
Abstract
INTRODUCTION Cyclic vomiting syndrome (CVS) imposes a substantial burden, but epidemiological data are scarce. This study aimed to estimate the incidence and prevalence of CVS, comorbid conditions, and treatment patterns, using administrative databases in the United States. METHODS This cross-sectional study used claims data from Merative MarketScan Commercial/Medicare Supplemental and Medicaid databases in all health care settings. Incidence and prevalence rates for 2019 were calculated and stratified by age, sex, region, and race/ethnicity. Patient characteristics were reported among newly diagnosed patients with CVS (i.e., no documented claims for CVS before 2019). CVS was defined as having 1+ inpatient and/or 2+ outpatient CVS claims that were 7+ days apart. RESULTS The estimated prevalence of CVS was 16.7 (Commercial/Medicare) and 42.9 (Medicaid) per 100,000 individuals. The incidence of CVS was estimated to be 10.6 (Commercial/Medicare) and 26.6 (Medicaid) per 100,000 individuals. Both prevalence and incidence rates were higher among female individuals (for both Commercial/Medicare and Medicaid). Comorbid conditions were common and included abdominal pain (56%-64%), anxiety (32%-39%), depression (26%-34%), cardiac conditions (39%-42%), and gastroesophageal reflux disease (30%-40%). Despite a diagnosis of CVS, only 32%-35% had prescriptions for prophylactic treatment and 47%-55% for acute treatment within the first 30-day period following diagnosis. DISCUSSION This study provides the first population-level estimates of CVS incidence and prevalence in the United States. Comorbid conditions are common, and most patients with CVS do not receive adequate treatment. These findings underscore the need for improving disease awareness and developing better screening strategies and effective treatments.
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Affiliation(s)
| | | | | | - Camilla Richmond
- Takeda Development Center of Americas, Cambridge, Massachusetts, USA
| | - James Williams
- Takeda Development Center of Americas, Cambridge, Massachusetts, USA
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Effect of Insurance Status on Mortality in Adults With Sarcoma of the Extremities and Pelvis: A SEER-Medicare Study. J Am Acad Orthop Surg 2023; 31:e14-e22. [PMID: 36548154 DOI: 10.5435/jaaos-d-21-01071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 07/30/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Previous studies have highlighted the association between insurance status and poor outcomes after surgical treatment of sarcomas in the United States.1-3 It is unclear how much of this disparity is mediated by confounding factors such as medical comorbidities and socioeconomic status and how much can be explained by barriers to care caused by insurance status. METHODS Surveillance, Epidemiology, and End Results-Medicare linkage data were procured for 7,056 patients undergoing treatment for bone and soft-tissue sarcomas in the extremities diagnosed between 2006 and 2013. A Cox proportional hazards model was used to assess the relative contributions of insurance status, medical comorbidities, tumor factors, treatment characteristics, and other demographic factors (race, household income, education level, and urban/rural status) to overall survival. RESULTS Patients with Medicaid insurance had a 28% higher mortality rate over the period studied, compared with patients with private insurance (hazard ratio, 1.28; 95% confidence interval, 1.03 to 1.60, P = 0.026), even when accounting for all other confounding variables. The 28% higher mortality rate associated with having Medicaid insurance was equivalent to being approximately 10 years older at the time of diagnosis or having a Charlson comorbidity index of 4 rather than zero (hazard ratio, 1.27). DISCUSSION Insurance status is an independent predictor of mortality from sarcoma, with 28% higher mortality in those with pre-expansion Medicaid.4,5 This association between insurance status and higher mortality held true even when accounting for numerous other confounding factors. Additional study is necessary into the mechanism for this healthcare disparity for the uninsured and underinsured, as well as strategies to resolve this inequality.
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Zhao J, Han X, Nogueira L, Fedewa SA, Jemal A, Halpern MT, Yabroff KR. Health insurance status and cancer stage at diagnosis and survival in the United States. CA Cancer J Clin 2022; 72:542-560. [PMID: 35829644 DOI: 10.3322/caac.21732] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/29/2022] [Accepted: 05/02/2022] [Indexed: 12/30/2022] Open
Abstract
Previous studies using data from the early 2000s demonstrated that patients who were uninsured were more likely to present with late-stage disease and had worse short-term survival after cancer diagnosis in the United States. In this report, the authors provide comprehensive data on the associations of health insurance coverage type with stage at diagnosis and long-term survival in individuals aged 18-64 years who were diagnosed between 2010 and 2013 with 19 common cancers from the National Cancer Database, with survival follow-up through December 31, 2019. Compared with privately insured patients, Medicaid-insured and uninsured patients were significantly more likely to be diagnosed with late-stage (III/IV) cancer for all stageable cancers combined and separately. For all stageable cancers combined and for six cancer sites-prostate, colorectal, non-Hodgkin lymphoma, oral cavity, liver, and esophagus-uninsured patients with Stage I disease had worse survival than privately insured patients with Stage II disease. Patients without private insurance coverage had worse short-term and long-term survival at each stage for all cancers combined; patients who were uninsured had worse stage-specific survival for 12 of 17 stageable cancers and had worse survival for leukemia and brain tumors. Expanding access to comprehensive health insurance coverage is crucial for improving access to cancer care and outcomes, including stage at diagnosis and survival.
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Affiliation(s)
- Jingxuan Zhao
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Xuesong Han
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Leticia Nogueira
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Stacey A Fedewa
- Department of Hematology and Oncology, Emory University, Atlanta, Georgia
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Michael T Halpern
- National Cancer Institute at the National Institutes of Health, Bethesda, Maryland
| | - K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
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Koroukian SM, Dong W, Albert JM, Kim U, Eom KY, Rose J, Owusu C, Zanotti KM, Cooper GS, Tsui J. Post-Affordable Care Act Improvements in Cancer Stage Among Ohio Medicaid Beneficiaries Resulted From an Increase in Stable Coverage. Med Care 2022; 60:821-830. [PMID: 36098269 DOI: 10.1097/mlr.0000000000001779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The mechanisms underlying improvements in early-stage cancer at diagnosis following Medicaid expansion remain unknown. We hypothesized that Medicaid expansion allowed for low-income adults to enroll in Medicaid before cancer diagnosis, thus increasing the number of stably-enrolled relative to those who enroll in Medicaid only after diagnosis (emergently-enrolled). METHODS Using data from the 2011-2017 Ohio Cancer Incidence Surveillance System and Medicaid enrollment files, we identified individuals diagnosed with incident invasive breast (n=4850), cervical (n=1023), and colorectal (n=3363) cancer. We conducted causal mediation analysis to estimate the direct effect of pre- (vs. post-) expansion on being diagnosed with early-stage (-vs. regional-stage and distant-stage) disease, and indirect (mediation) effect through being in the stably- (vs. emergently-) enrolled group, controlling for individual-level and area-level characteristics. RESULTS The percentage of stably-enrolled patients increased from 63.3% to 73.9% post-expansion, while that of the emergently-enrolled decreased from 36.7% to 26.1%. The percentage of patients with early-stage diagnosis remained 1.3-2.9 times higher among the stably-than the emergently-enrolled group, both pre-expansion and post-expansion. Results from the causal mediation analysis showed that there was an indirect effect of Medicaid expansion through being in the stably- (vs. emergently-) enrolled group [risk ratios with 95% confidence interval: 1.018 (1.010-1.027) for breast cancer, 1.115 (1.064-1.167) for cervical cancer, and 1.090 (1.062-1.118) for colorectal cancer. CONCLUSION We provide the first evidence that post-expansion improvements in cancer stage were caused by an increased reliance on Medicaid as a source of stable insurance coverage.
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Affiliation(s)
- Siran M Koroukian
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University
- Case Comprehensive Cancer Center, Case Western Reserve University
- Center for Community Health Integration, School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Weichuan Dong
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University
| | - Jeffrey M Albert
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University
| | - Uriel Kim
- Kellogg School of Management, Northwestern University, Evanston, IL
| | - Kirsten Y Eom
- Public Health Research Institute, The MetroHealth System and Case Western Reserve University
| | - Johnie Rose
- Case Comprehensive Cancer Center, Case Western Reserve University
- Center for Community Health Integration, School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Cynthia Owusu
- Case Comprehensive Cancer Center, Case Western Reserve University
- Department of Internal Medicine, University Hospitals of Cleveland, School of Medicine, Case Western Reserve University
| | - Kristine M Zanotti
- Case Comprehensive Cancer Center, Case Western Reserve University
- Department of Obstetrics and Gynecology, Gynecologic Oncology, University Hospitals of Cleveland, School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Gregory S Cooper
- Case Comprehensive Cancer Center, Case Western Reserve University
- Department of Internal Medicine, University Hospitals of Cleveland, School of Medicine, Case Western Reserve University
| | - Jennifer Tsui
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
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Kim A, Sadayuki T. The Effects of the Medicaid Expansion on Prescription Drug Behavior. Popul Health Manag 2022; 25:677-683. [PMID: 35861714 DOI: 10.1089/pop.2022.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The objective of this empirical exercise was to examine how drug providers in states that implemented the Medicaid expansion in 2014 reacted to the expansion compared with providers in states where Medicare was not expanded. Medicaid beneficiaries have been susceptible to higher cost and lower quality of health care. The Affordable Care Act increased access to drugs for uninsured people. Numerous studies highlighted the effects of the Medicaid expansion on beneficiaries. However, there is a gap in the literature that looks at prescription behavior of physicians during the Medicaid expansion that compared expanded states versus nonexpanded states. A difference-in-differences regression was used to estimate the average treatment effect of implementing the Medicaid expansion on each of the 6 outcomes of interest: (1) total cost of prescribing drugs, (2) number of total drug claims for non-Medicaid beneficiaries, (3) number of drug claims for Medicaid beneficiaries, (4) number of beneficiaries, (5) number of beneficiaries who were 65 years old or older, and (6) ratio of brand-name drugs. To address potential estimation biases, a matching procedure was used to ensure that pre- and post-Medicaid period trends were parallel. Our results provide evidence that, on average, the Medicaid expansion led each provider in expanded states prescribed more drugs for beneficiaries with low-income subsidies, whereas prescribed less drugs for other beneficiaries including those over 65 years old. The authors also show the proportion of brand-name drugs prescribed by a provider in expanded states declined due to the implementation of the Medicaid expansion. These results suggests that the Medicaid expansion has contributed to increasing access to health care by low-income citizens who were in need of prescriptions.
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Affiliation(s)
- Andrew Kim
- School of Health Science, Mount Pleasant, Michigan, USA
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Ermer T, Canavan ME, Maduka RC, Li AX, Salazar MC, Kaminski MF, Pichert MD, Zhan PL, Mase V, Kluger H, Boffa DJ. Association Between Food and Drug Administration Approval and Disparities in Immunotherapy Use Among Patients With Cancer in the US. JAMA Netw Open 2022; 5:e2219535. [PMID: 35771575 PMCID: PMC9247736 DOI: 10.1001/jamanetworkopen.2022.19535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 05/12/2022] [Indexed: 11/23/2022] Open
Abstract
Importance Clinical trials and compassionate use agreements provide selected patients with access to potentially life-saving treatments before approval by the Food and Drug Administration (FDA). Approval from the FDA decreases a number of access barriers; however, it is unknown whether FDA approval is associated with increases in the equitable use of novel therapies and reductions in disparities in use among patients with cancer in the US. Objective To assess the association between FDA drug approval and disparities in the use of immunotherapy across health, sociodemographic, and socioeconomic strata before and after approval of the first checkpoint inhibitors for the treatment of patients with cancer in the US. Design, Setting, and Participants This cohort study used data from the National Cancer Database to examine the use of immunotherapy across health, sociodemographic, and socioeconomic strata before and after FDA approval of the first checkpoint inhibitor therapies. A total of 402 689 patients 20 years or older who were diagnosed with stage IV non-small cell lung cancer (NSCLC), renal cell carcinoma (RCC), or melanoma of the skin between January 1, 2007, and December 31, 2018 (specific years varied by tumor type), were included. Exposures Patient health (Charlson-Deyo comorbidity score and age), sociodemographic characteristics (sex, race, and ethnicity), and socioeconomic (insurance status and household income based on zip code of residence) characteristics. Main Outcomes and Measures The association of patient characteristics with receipt of immunotherapy was evaluated in the 4 years before and the 3 years immediately after FDA approval using multivariable logistic regression modeling. Results Among 402 689 patients (median [IQR] age, 68 [60-76 years]; 225 081 men [55.9%]), 347 233 had NSCLC, 43 714 had RCC, and 11 742 patients had melanoma. A total of 47 527 patients (11.8%) were Black, 15 763 (3.9%) were Hispanic, 375 874 (93.3%) were non-Hispanic, 335 833 (83.4%) were White, and 16 553 (4.1%) were of other races. Before FDA approval, 6271 patients (3.2%) with NSCLC, 1155 patients (4.8%) with RCC, and 504 patients (8.6%) with melanoma received immunotherapy compared with 23 908 patients (15.6%) with NSCLC, 3890 patients (19.7%) with RCC, and 1143 patients (19.3%) with melanoma after FDA approval. Before FDA approval, sociodemographic and socioeconomic characteristics were associated with variable immunotherapy administration by tumor type. For example, among those with NSCLC, Black patients were less likely to receive immunotherapy than White patients (odds ratio [OR], 0.78; 95% CI ,0.71-0.85; P < .001); among those with RCC, uninsured patients were less likely to receive immunotherapy than privately insured patients (OR, 0.31; 95% CI, 0.20-0.48; P < .001). After FDA approval, most disparities persisted, but several narrowed (eg, Black patients with NSCLC: OR, 0.87 [95% CI, 0.83-0.91; P < .001]; uninsured patients with RCC: OR, 0.60 [95% CI, 0.48-0.75; P < .001]). Although many disparities remained, some gaps across socioeconomic characteristics appeared to widen (eg, patients with NSCLC in the lowest vs highest income quartile: OR, 0.80; 95% CI, 0.76-0.83; P < .001), and new gaps emerged (eg, Black patients with RCC: OR, 0.82; 95% CI, 0.72-0.93; P = .003). Conclusions and Relevance In this cohort study, disparities in immunotherapy use existed across a number of sociodemographic and socioeconomic characteristics among patients with NSCLC, RCC, and melanoma before FDA approval, including during the important period when clinical trials were accruing patients. Although FDA approval was associated with a significant increase in the use of immunotherapy, gaps persisted, suggesting that FDA approval may not eliminate disparities in the use of novel therapies.
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Affiliation(s)
- Theresa Ermer
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
- Faculty of Medicine, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Maureen E. Canavan
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
- Cancer Outcomes Public Policy and Effectiveness Research Center, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Richard C. Maduka
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Andrew X. Li
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | | | | | - Matthew D. Pichert
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Peter L. Zhan
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Vincent Mase
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Harriet Kluger
- Section of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Daniel J. Boffa
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
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Hu X, Fujiwara T, Houdek MT, Chen L, Huang W, Sun Z, Sun Y, Yan W. Impact of racial disparities and insurance status in patients with bone sarcomas in the USA : a population-based cohort study. Bone Joint Res 2022; 11:278-291. [PMID: 35549518 PMCID: PMC9130676 DOI: 10.1302/2046-3758.115.bjr-2021-0258.r2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aims Socioeconomic and racial disparities have been recognized as impacting the care of patients with cancer, however there are a lack of data examining the impact of these disparities on patients with bone sarcoma. The purpose of this study was to examine socioeconomic and racial disparities that impact the oncological outcomes of patients with bone sarcoma. Methods We reviewed 4,739 patients diagnosed with primary bone sarcomas from the Surveillance, Epidemiology and End Results (SEER) registry between 2007 and 2015. We examined the impact of race and insurance status associated with the presence of metastatic disease at diagnosis, treatment outcome, and overall survival (OS). Results Patients with Medicaid (odds ratio (OR) 1.41; 95% confidence interval (CI) 1.15 to 1.72) and uninsured patients (OR 1.90; 95% CI 1.26 to 2.86) had higher risks of metastatic disease at diagnosis compared to patients with health insurance. Compared to White patients, Black (OR 0.63, 95% CI 0.47 to 0.85) and Asian/Pacific Islander (OR 0.65, 95% CI 0.46 to 0.91) were less likely to undergo surgery. In addition, Black patients were less likely to receive chemotherapy (OR 0.67, 95% CI 0.49 to 0.91) compared to White patients. In patients with chondrosarcoma, those with Medicaid had worse OS compared to patients with insurance (hazard ratio (HR) 1.65, 95% CI 1.06 to 2.56). Conclusion In patients with a bone sarcoma, the cancer stage at diagnosis varied based on insurance status, and racial disparities were identified in treatment. Further studies are needed to identify modifiable factors which can mitigate socioeconomic and racial disparities found in patients with bone sarcomas. Cite this article: Bone Joint Res 2022;11(5):278–291.
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Affiliation(s)
- Xianglin Hu
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Tomohiro Fujiwara
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Matthew T Houdek
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Lingxiao Chen
- Faculty of Medicine and Health, University of Sydney, The Kolling Institute, Sydney, Australia
| | - Wending Huang
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhengwang Sun
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yangbai Sun
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wangjun Yan
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Lin M, O'Guinn M, Zipprer E, Hsieh JC, Dardon AT, Raman S, Foglia CM, Chao SY. Impact of Medicaid Expansion on the Diagnosis, Treatment, and Outcomes of Stage II and III Rectal Cancer Patients. J Am Coll Surg 2022; 234:54-63. [PMID: 35213460 DOI: 10.1097/xcs.0000000000000010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Insurance status has been associated with disparities in stage at cancer diagnosis. We examined how Medicaid expansion (ME) impacted diagnoses, surgical treatment, use of neoadjuvant therapies (NCRT), and outcomes for Stage II and III rectal cancer. STUDY DESIGN We used 2010-2017 American College of Surgeons National Cancer Database (NCDB) to identify patients ages 18-65, with Medicaid as primary form of payment, and were diagnosed with Stage II or III rectal cancer. Patients were stratified based on Census bureau division's ME adoption rates of High, Medium, Low. Overall trends were examined, and patient characteristics and outcomes were compared before and after ME date of 1/1/2014. RESULTS Over 8 years of NCDB data examined, there was an increasing trend of Stage II and III rectal cancer diagnoses, surgical resection, and use of NCRT for Medicaid patients. We observed an increase in age, proportion of White Medicaid patients in Low ME divisions, and proportion of fourth income quartile patients in High ME divisions. Univariate analysis showed decreased use of open surgery for all 3 categories after ME, but adjusted odds ratios (aOR) were not significant based on multivariate analysis. NCRT utilization increased after ME for all 3 ME adoption categories and aOR significantly increased for Low and High ME divisions. ME significantly decreased 90-day mortality. CONCLUSIONS Medicaid expansion had important impacts on increasing Stage II and III rectal cancer diagnoses, use of NCRT, and decreased 90-day mortality for patients with Medicaid. Our study supports increasing health insurance coverage to improve Medicaid patient outcomes in rectal cancer care.
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Affiliation(s)
- Mayin Lin
- From the MercyOne Des Moines Surgical Group (Lin, Raman), Des Moines, IA
- the Department of Surgery, Creighton University, Omaha, NE (Lin, Raman)
| | - Makayla O'Guinn
- the General Surgery Residency Program, MercyOne Des Moines Medical Center (O'Guinn, Zipprer), Des Moines, IA
| | - Elizabeth Zipprer
- the General Surgery Residency Program, MercyOne Des Moines Medical Center (O'Guinn, Zipprer), Des Moines, IA
| | - John C Hsieh
- the Department of Animal Science, Iowa State University, Ames, IA (Hsieh)
| | - Arturo Torices Dardon
- the General Surgery Residency Program, NewYork-Presbyterian/Queens, Flushing, NY (Dardon)
| | - Shankar Raman
- From the MercyOne Des Moines Surgical Group (Lin, Raman), Des Moines, IA
- the Department of Surgery, Creighton University, Omaha, NE (Lin, Raman)
| | - Christopher M Foglia
- the Department of Surgery, NewYork-Presbyterian/Queens, Weill Cornell Medicine, Flushing, NY (Foglia, Chao)
| | - Steven Y Chao
- the Department of Surgery, NewYork-Presbyterian/Queens, Weill Cornell Medicine, Flushing, NY (Foglia, Chao)
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Xie E, Colditz GA, Lian M, Greever-Rice T, Schmaltz C, Lucht J, Liu Y. OUP accepted manuscript. JNCI Cancer Spectr 2022; 6:6570595. [PMID: 35583139 PMCID: PMC9113434 DOI: 10.1093/jncics/pkac031] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 02/01/2022] [Accepted: 03/21/2022] [Indexed: 12/03/2022] Open
Abstract
Background Disrupted and delayed Medicaid coverage has been consistently associated with lower rates of cancer screening and early-stage cancer diagnosis compared with continuous coverage. However, the relationships between Medicaid coverage timing, breast cancer treatment delays, and survival are less clear. Methods Using the linked Missouri Cancer Registry-Medicaid claims data, we identified 4583 women diagnosed with breast cancer between 2007 and 2016. We used logistic regression to estimate odds ratios (ORs) of late-stage diagnosis and treatment delays for prediagnosis (>30 days, >90 days, and >1 year before diagnosis) vs peridiagnosis enrollment. Cox proportional hazards models were used to estimate the hazard ratio (HR) of breast cancer-specific mortality for pre- vs postdiagnosis enrollment. Results Patients enrolled in Medicaid more than 30 days before diagnosis were less likely to be diagnosed at a late stage compared with those enrolled in Medicaid peridiagnosis (OR = 0.69, 95% confidence interval [CI] = 0.60 to 0.79). This result persisted using enrollment 90-day (OR = 0.64, 95% CI = 0.56 to 0.74) and 1-year thresholds (OR = 0.55, 95% CI = 0.47 to 0.65). We did not observe a difference in the likelihood of treatment delays between the 2 groups. After adjustment for sociodemographic factors, there was no statistically significant difference in the risk of breast cancer mortality for patients enrolled more than 30 days prediagnosis relative to patients enrolled peridiagnosis (HR = 0.98, 95% CI = 0.83 to 1.14), but a lower risk was observed for patients enrolled prediagnosis when using 90 days (HR = 0.85, 95% CI = 0.72 to 0.999) or 1 year (HR = 0.79, 95% CI = 0.66 to 0.96) as the threshold. Conclusions Women with breast cancer who enroll in Medicaid earlier may benefit from earlier diagnoses, but only longer-term enrollment may have survival benefits.
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Affiliation(s)
- Evaline Xie
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO, USA
| | - Min Lian
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO, USA
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Chester Schmaltz
- Department of Health Management and Informatics, University of Missouri School of Medicine, Columbia, MO, USA
| | - Jill Lucht
- Center for Health Policy, University of Missouri, Columbia, MO, USA
| | - Ying Liu
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO, USA
- Correspondence to: Ying Liu, MD, PhD, 660 South Euclid Ave, Campus Box 8100, St. Louis, MO 63110, USA (e-mail: )
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Moawad GN, Klebanoff JS, Rahman S, Kazma J, Amdur R, Nishikawa MI, Maassen MS, Tyan P. Discrepancies in Access to Minimally Invasive Gynecologic Surgery Care Between Privately and Publicly Insured Patients. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gaby N. Moawad
- Department of Obstetrics and Gynecology and The George Washington University Hospital, Washington, District of Columbia, USA
| | - Jordan S. Klebanoff
- Department of Obstetrics and Gynecology and The George Washington University Hospital, Washington, District of Columbia, USA
| | - Sara Rahman
- Department of Obstetrics and Gynecology and The George Washington University Hospital, Washington, District of Columbia, USA
| | - Jamil Kazma
- Department of Obstetrics and Gynecology and The George Washington University Hospital, Washington, District of Columbia, USA
| | - Richard Amdur
- Department of Surgery, The George Washington University Hospital, Washington, District of Columbia, USA
| | - Moena I. Nishikawa
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Marloes S. Maassen
- Department of Obstetrics and Gynaecology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Paul Tyan
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Bradley CJ, Stevens JL, Enewold L, Warren JL. Stage and mortality of low-income patients with cancer: Evidence from SEER-Medicaid. Cancer 2020; 127:229-238. [PMID: 33107990 DOI: 10.1002/cncr.33207] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND A national data source for identifying patients with cancer enrolled in Medicaid is needed to evaluate cancer care for low-income, publicly insured patients. In this study, a population-based data set of patients diagnosed with cancer and enrolled in Medicaid was created and evaluated. The objective was to compare the characteristics of patients with cancer identified in Surveillance, Epidemiology, and End Results (SEER) data and linked to the Medicaid Analytic eXtract (MAX) Personal Summary files with the characteristics of patients who were not linked to the MAX file. METHODS All persons in 14 SEER registries diagnosed with cancer from 2006 to 2013 who were or were not linked to the 2006-2013 nationwide MAX files were selected, and patient demographic characteristics were compared for 3 age groups. Common cancer sites and the timing of Medicaid enrollment with respect to patients' cancer diagnoses were reported, and the stage at diagnosis and 4-year mortality were compared by 3 categories of Medicaid enrollment. RESULTS Approximately 18% of the sample was enrolled in Medicaid within 25 months of diagnosis. Enrollees had a greater proportion of racial/ethnic minorities in comparison with patients who were not enrolled. A late-stage diagnosis was more common among Medicaid patients and particularly among those who enrolled after their diagnosis. For every common cancer site, mortality was highest in the sample of Medicaid patients who enrolled after their diagnosis. CONCLUSIONS The Medicaid enrollment data newly added to SEER records enhance researchers' ability to investigate research questions related to Medicaid policies and care delivery. For patients enrolled before their diagnosis, Medicaid appears to offer protection against late-stage disease and mortality.
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Affiliation(s)
- Cathy J Bradley
- School of Public Health, University of Colorado, Aurora, Colorado
| | | | - Lindsey Enewold
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Joan L Warren
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
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12
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Zhao J, Han X, Nogueira L, Zheng Z, Jemal A, Yabroff KR. Health Insurance Coverage Disruptions and Access to Care and Affordability among Cancer Survivors in the United States. Cancer Epidemiol Biomarkers Prev 2020; 29:2134-2140. [PMID: 32868319 DOI: 10.1158/1055-9965.epi-20-0518] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/30/2020] [Accepted: 08/17/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Lack of health insurance is associated with having problems with access to high-quality care. We estimated prevalence and evaluated associations of insurance coverage disruptions and access to health care and affordability among cancer survivors in the United States. METHODS Adult cancer survivors ages 18 to 64 years with current private or public health insurance were identified from the 2011 to 2018 National Health Interview Survey (n = 7,186). Health insurance coverage disruption was measured as self-reports of any time in the prior year without coverage. Outcomes included preventive services use, problems with care affordability, and cost-related medication nonadherence in the prior year. We used separate multivariable logistic models to evaluate associations between coverage disruptions and study outcomes by current insurance coverage. RESULTS Among currently insured survivors, 3.7% [95% confidence interval (95% CI), 3.0%-4.4%] with private, and 7.8% (95% CI, 6.5%-9.4%) with public insurance reported coverage disruptions in 2011 to 2018. We estimated that approximately 260,000 survivors ages 18 to 64 years had coverage disruptions in 2018. Among privately and publicly insured survivors, those with coverage disruptions were less likely to report all preventive services use (16.9% vs. 36.2%; 14.6% vs. 25.3%, respectively) and more likely to report any problems with care affordability (55.0% vs. 17.7%; 71.1% vs. 38.4%, respectively) and any cost-related medication nonadherence (39.4% vs. 10.1%; 36.5% vs. 16.3%, respectively) compared with those continuously insured (all P < 0.05). CONCLUSIONS Coverage disruptions in the prior year were associated with problems with health care access and affordability among currently insured survivors. IMPACT Reducing coverage disruptions may help improve access and affordability for survivors.
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Affiliation(s)
- Jingxuan Zhao
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia.
| | - Xuesong Han
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Leticia Nogueira
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Zhiyuan Zheng
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - K Robin Yabroff
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
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13
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Yabroff KR, Reeder-Hayes K, Zhao J, Halpern MT, Lopez AM, Bernal-Mizrachi L, Collier AB, Neuner J, Phillips J, Blackstock W, Patel M. Health Insurance Coverage Disruptions and Cancer Care and Outcomes: Systematic Review of Published Research. J Natl Cancer Inst 2020; 112:671-687. [PMID: 32337585 PMCID: PMC7357319 DOI: 10.1093/jnci/djaa048] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/12/2020] [Accepted: 03/27/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Lack of health insurance coverage is associated with poor access and receipt of cancer care and survival in the United States. Disruptions in coverage are common among low-income populations, but little is known about associations of disruptions with cancer care, including prevention, screening, and treatment, as well as outcomes of stage at diagnosis and survival. METHODS We conducted a systematic review of studies of health insurance coverage disruptions and cancer care and outcomes published between 1980 and 2019. We used the PubMed, EMBASE, Scopus, and CINAHL databases and identified 29 observational studies. Study characteristics and key findings were abstracted and synthesized qualitatively. RESULTS Studies evaluated associations between coverage disruptions and prevention or screening (31.0%), treatment (13.8%), end-of-life care (10.3%), stage at diagnosis (44.8%), and survival (20.7%). Coverage disruptions ranged from 4.3% to 32.8% of patients age-eligible for breast, cervical, or colorectal cancer screening. Between 22.1% and 59.5% of patients with Medicaid gained coverage only at or after cancer diagnosis. Coverage disruptions were consistently statistically significantly associated with lower receipt of prevention, screening, and treatment. Among patients with cancer, those with Medicaid disruptions were statistically significantly more likely to have advanced stage (odds ratios = 1.2-3.8) and worse survival (hazard ratios = 1.28-2.43) than patients without disruptions. CONCLUSIONS Health insurance coverage disruptions are common and adversely associated with receipt of cancer care and survival. Improved data infrastructure and quasi-experimental study designs will be important for evaluating the associations of federal and state policies on coverage disruptions and care and outcomes.
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Affiliation(s)
- K Robin Yabroff
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| | - Katherine Reeder-Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Jingxuan Zhao
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| | - Michael T Halpern
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Ana Maria Lopez
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Anderson B Collier
- Children’s Cancer Center, The University of Mississippi Medical Center, Jackson, MS, USA
| | - Joan Neuner
- Medical College of Wisconsin, Milwaukee, WI, USA
| | | | | | - Manali Patel
- Stanford University School of Medicine, Stanford, CA, USA
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14
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Keegan THM, Parsons HM, Chen Y, Maguire FB, Morris CR, Parikh-Patel A, Kizer KW, Wun T. Impact of Health Insurance on Stage at Cancer Diagnosis Among Adolescents and Young Adults. J Natl Cancer Inst 2020; 111:1152-1160. [PMID: 30937440 DOI: 10.1093/jnci/djz039] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 01/01/2019] [Accepted: 03/22/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Uninsured adolescents and young adults (AYAs) and those with publicly funded health insurance are more likely to be diagnosed with cancer at later stages. However, prior population-based studies have not distinguished between AYAs who were continuously uninsured from those who gained Medicaid coverage at the time of cancer diagnosis. METHODS AYA patients (ages 15-39 years) with nine common cancers diagnosed from 2005 to 2014 were identified using California Cancer Registry data. This cohort was linked to California Medicaid enrollment files to determine continuous enrollment, discontinuous enrollment, or enrollment at diagnosis, with other types of insurance determined from registry data. Multivariable logistic regression was used to evaluate factors associated with later stages at diagnosis. RESULTS The majority of 52 774 AYA cancer patients had private or military insurance (67.6%), followed by continuous Medicaid (12.4%), Medicaid at diagnosis (8.5%), discontinuous Medicaid (3.9%), other public insurance (1.6%), no insurance (2.9%), or unknown insurance (3.1%). Of the 13 069 with Medicaid insurance, 50.1% were continuously enrolled. Compared to those who were privately insured, AYAs who enrolled in Medicaid at diagnosis were 2.2-2.5 times more likely to be diagnosed with later stage disease, whereas AYAs discontinuously enrolled were 1.7-1.9 times and AYAs continuously enrolled were 1.4-1.5 times more likely to be diagnosed with later stage disease. Males, those residing in lower socioeconomic neighborhoods, and AYAs of Hispanic or black race and ethnicity (vs non-Hispanic white) were more likely to be diagnosed at a later stage, independent of insurance. CONCLUSIONS Our findings suggest that access to continuous medical insurance is important for decreasing the likelihood of late stage cancer diagnosis.
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Abstract
BACKGROUND This study examines the expansion of health insurance coverage in Massachusetts under state health reform as a natural experiment to investigate whether expanded insurance coverage reduced the likelihood of advanced stage colorectal cancer (CRC) and breast cancer (BCA) diagnosis. METHODS Our study populations include CRC or BCA patients aged 50-64 years observed in the Massachusetts Cancer Registry and Surveillance Epidemiology and End Results (SEER) registries for 2001-2013. We use difference-in-differences regression models to estimate changes in the likelihood of advanced stage diagnosis after Massachusetts health reform, relative to comparison states without expanded coverage (Connecticut, New Jersey, Georgia, Kentucky, and Michigan). RESULTS We find some suggestive evidence of a decline in the proportion of advanced stage CRC cases. Approximately half of the CRC patients in Massachusetts and control states were diagnosed at advanced stages pre reform; there was a 2 percentage-point increase in this proportion across control states and slight decline in Massachusetts post reform. Adjusted difference-in-difference estimates suggest a 3.4 percentage-point (P=0.005) or 7% decline, relative to Massachusetts baseline, in the likelihood of advanced stage diagnosis after the reform in Massachusetts, though this result is sensitive to years included in the analysis. We did not find a significant effect of reform on BCA stage at diagnosis. CONCLUSIONS The decline in the likelihood of advanced stage CRC diagnosis after Massachusetts health reform may suggest improvements in access to health care and CRC screening. Similar declines were not observed for BCA, perhaps due to established BCA-specific safety-net programs.
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16
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Warren JL, Benner S, Stevens J, Enewold L, Huang B, Zhao L, Tilahun N, Bradley CJ. Development and Evaluation of a Process to Link Cancer Patients in the SEER Registries to National Medicaid Enrollment Data. J Natl Cancer Inst Monogr 2020; 2020:89-95. [PMID: 32412075 PMCID: PMC7868030 DOI: 10.1093/jncimonographs/lgz035] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/19/2019] [Accepted: 12/10/2019] [Indexed: 11/14/2022] Open
Abstract
Cancer patients receiving Medicaid have worse prognosis. Patients in 14 Surveillance, Epidemiology, and End Results (SEER) cancer registries were linked to national Medicaid enrollment files, 2006-2013, to determine enrollment status during the year before and after diagnosis. A deterministic algorithm based on Social Security number, Medicare Health Insurance Claim number, sex, and date of birth was utilized. Results were compared with an independent linkage of Kentucky-based SEER and Medicaid data. A total 559 484 cancer cases were linked to national Medicaid enrollment files, representing 15-17% of persons with cancer yearly. About 60% of these cases were a complete match on all variables. There was 99% agreement on enrollment status compared with the Kentucky linked data. SEER data were successfully linked to national Medicaid enrollment data. NCI will make the linked data available to researchers, allowing for more detailed assessments of the impact Medicaid enrollment has on cancer diagnosis and outcomes.
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Affiliation(s)
- Joan L Warren
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Science, National Cancer Institute, Bethesda, MD
| | | | | | - Lindsey Enewold
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Science, National Cancer Institute, Bethesda, MD
| | - Bin Huang
- Department of Biostatistics, College of Public Health, Markey Cancer Center, University of Kentucky, Lexington, KY
| | - Lirong Zhao
- Division of Data, Research, and Analytic Methods, Center for Medicare & Medicaid Innovation, Centers for Medicare and Medicaid Services, Baltimore, MD
| | - Negussie Tilahun
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Science, National Cancer Institute, Bethesda, MD
| | - Cathy J Bradley
- Department of Health Systems, Management and Policy, School of Public Health, University of Colorado, Aurora, CO
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17
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Is There an Association Between Insurance Status and Survival and Treatment of Primary Bone and Extremity Soft-tissue Sarcomas? A SEER Database Study. Clin Orthop Relat Res 2020; 478:527-536. [PMID: 31390340 PMCID: PMC7145069 DOI: 10.1097/corr.0000000000000889] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Several recently published population-based studies have highlighted the association between insurance status and survival in patients with various cancers such as breast, head and neck, testicular, and lymphoma [22, 24, 38, 41]. Generally, these studies demonstrate that uninsured patients or those with Medicaid insurance had poorer survival than did those who had non-Medicaid insurance. However, this discrepancy has not been studied in patients with primary bone and extremity soft-tissue sarcomas, a unique oncological population that typically presents late in the disease course and often requires referral and complex treatment at tertiary care centers-issues that health insurance coverage disparities could aggravate. QUESTIONS/PURPOSES (1) What is the relationship between insurance status and cause-specific mortality? (2) What is the relationship between insurance status and the prevalence of distant metastases? (3) What is the relationship between insurance status and the proportion of limb salvage surgery versus amputation? METHODS The Surveillance, Epidemiology, and End Results database (SEER) was used to identify a total of 12,008 patients: 4257 patients with primary bone sarcomas and 7751 patients with extremity soft-tissue sarcomas, who were diagnosed and treated between 2007 and 2014. Patients were categorized into one of three insurance groups: insured with non-Medicaid insurance, insured with Medicaid, and uninsured. Patients without information available regarding insurance status were excluded (2.7% [113 patients] with primary bone sarcomas and 3.1% [243 patients] with extremity soft-tissue sarcomas.) The association between insurance status and survival was assessed using a Cox proportional hazards regression analysis adjusted for patient age, sex, race, ethnicity, extent of disease (lymph node and metastatic involvement), tumor grade, tumor size, histology, and primary tumor site. RESULTS Patients with primary bone sarcomas with Medicaid insurance had reduced disease-specific survival than did patients with non-Medicaid insurance (hazard ratio 1.3 [95% confidence interval 1.1 to 1.6]; p = 0.003). Patients with extremity soft-tissue sarcomas with Medicaid insurance also had reduced disease-specific survival compared with those with non-Medicaid insurance (HR 1.2 [95% CI 1.0 to 1.5]; p = 0.019). Patients with primary bone sarcomas (relative risk 1.8 [95% CI 1.3 to 2.4]; p < 0.001) and extremity soft-tissue sarcomas (RR 2.4 [95% CI 1.9 to 3.1]; p < 0.001) who had Medicaid insurance were more likely to have distant metastases at the time of diagnosis than those with non-Medicaid insurance. Patients with primary bone sarcomas (RR 1.8 [95% CI 1.4 to 2.1]; p < 0.001), and extremity soft-tissue sarcomas (RR 2.4 [95% CI 1.9 to 3.0]; p < 0.001) that had Medicaid insurance were more likely to undergo amputation than patients with non-Medicaid insurance. Patients with primary bone and extremity soft-tissue sarcomas who were uninsured were not more likely to have distant metastases at the time of diagnosis and did not have a higher proportion of amputation surgery as compared with patients with non-Medicaid insurance. However, uninsured patients with extremity soft-tissue sarcomas still displayed reduction in disease-specific survival (HR 1.6 [95% CI 1.2 to 2.1]; p = 0.001). CONCLUSIONS Disparities manifested by differences in insurance status were correlated with an increased risk of metastasis at the time of diagnosis, reduced likelihood of treatment with limb salvage procedures, and reduced disease-specific survival in patients with primary bone or extremity soft-tissue sarcomas. Although several potentially confounding variables were controlled for, unmeasured confounding played a role in these results. Future studies should seek to identify what factors drive the finding that substandard insurance status is associated with poorer survival after a cancer diagnosis. Candidate variables might include medical comorbidities, treatment delays, time to first presentation to medical care and time to diagnosis, type of treatment received, distance travelled to treatments and transportation barriers, out-of-pocket payment burden, as well as educational and literacy status. These variables are almost certainly associated with socioeconomic deprivation in a vulnerable patient population, and once identified, treatment can become targeted to address these systemic inequities. LEVEL OF EVIDENCE Level III, therapeutic study.
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18
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Jin MC, Harris JP, Sabolch AN, Gensheimer M, Le QT, Beadle BM, Pollom EL. Proton radiotherapy and treatment delay in head and neck squamous cell carcinoma. Laryngoscope 2019; 130:E598-E604. [PMID: 31837165 DOI: 10.1002/lary.28458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/12/2019] [Accepted: 11/16/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE For patients with head and neck squamous cell carcinoma (HNSCC), delays in the initiation of radiotherapy (RT) have been closely associated with worse outcomes. We sought to investigate whether RT modality (proton vs. photon) is associated with differences in the time to initiation of RT. METHODS The National Cancer Database was queried for patients diagnosed with nonmetastatic HNSCC between 2004 and 2015 who received either proton or photon RT as part of their initial treatment. Wilcoxon rank-sum and chi-square tests were used to compare continuous and categorical variables, respectively. Multivariable logistic regression was used to determine the association between use of proton RT and delayed RT initiation. RESULTS A total of 175,088 patients with HNSCC receiving either photon or proton RT were identified. Patients receiving proton RT were more likely to be white, reside in higher income areas, and have private insurance. Proton RT was associated with delayed RT initiation compared to photon RT (median 59 days vs. 45, P < 0.001). Receipt of proton therapy was independently associated with RT initiation beyond 6 weeks after diagnosis (adjusted OR [aOR, definitive RT] = 1.69; 95% confidence interval [CI] 1.26-2.30) or surgery (aOR [adjuvant RT] = 4.08; 95% CI 2.64-6.62). In the context of adjuvant proton RT, increases in treatment delay were associated with worse overall survival (weeks, adjusted hazard ratio = 1.099, 95% CI 1.011-1.194). CONCLUSION Use of proton therapy is associated with delayed RT in both the definitive and adjuvant settings for patients with HNSCC and could be associated with poorer outcomes. LEVEL OF EVIDENCE 2b Laryngoscope, 122:0000-0000, 2019 Laryngoscope, 130:E598-E604, 2020.
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Affiliation(s)
- Michael C Jin
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford
| | - Jeremy P Harris
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford.,Palo Alto Veterans Affairs Health Care System, Palo Alto, California
| | - Aaron N Sabolch
- The Center for Health Research and the Department of Radiation Oncology, Kaiser Permanente, Portland, Oregon, U.S.A
| | - Michael Gensheimer
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford
| | - Beth M Beadle
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford
| | - Erqi L Pollom
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford.,Palo Alto Veterans Affairs Health Care System, Palo Alto, California
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19
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Goldstein JS, Switchenko JM, Behera M, Flowers CR, Koff JL. Insurance status impacts overall survival in Burkitt lymphoma. Leuk Lymphoma 2019; 60:3225-3234. [PMID: 31274033 PMCID: PMC6923579 DOI: 10.1080/10428194.2019.1623884] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/16/2019] [Accepted: 05/15/2019] [Indexed: 12/11/2022]
Abstract
The impact of insurance status on clinical outcomes in Burkitt (BL) and plasmablastic (PBL) lymphomas remains unknown. We used the National Cancer Database to examine insurance status' effect on overall survival (OS) in adults diagnosed with these lymphomas between 2004 and 2014. BL patients with private insurance had significantly better OS compared to those without. In patients aged <65 years, hazard ratios were 1.4 for uninsured status (95% confidence interval 1.2-1.7), 1.2 for Medicaid (95% CI 1.0-1.4), and 1.5 for Medicare (95% CI 1.2-1.9). For patients aged >65 years, hazard ratio for uninsured status was 8.4 (95% CI 2.5-28.3). Conversely, underinsured PBL patients experienced no difference in OS. Thus, expanding insurance-related access to care may improve survival in BL, for which curative therapy exists, but not PBL, where more effective therapies are needed. Our findings add to mounting evidence that adequate health insurance is particularly important for patients with curable cancers.
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Affiliation(s)
| | - Jeffrey M. Switchenko
- Department of Biostatistics and Bioinformatics, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Madhusmita Behera
- Department of Biostatistics and Bioinformatics, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Christopher R. Flowers
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Jean L. Koff
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
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20
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Ahmad TR, Chen LM, Chapman JS, Chen LL. Medicaid and Medicare payer status are associated with worse surgical outcomes in gynecologic oncology. Gynecol Oncol 2019; 155:93-97. [DOI: 10.1016/j.ygyno.2019.08.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/06/2019] [Accepted: 08/12/2019] [Indexed: 11/16/2022]
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Ellis L, Canchola AJ, Spiegel D, Ladabaum U, Haile R, Gomez SL. Trends in Cancer Survival by Health Insurance Status in California From 1997 to 2014. JAMA Oncol 2019; 4:317-323. [PMID: 29192307 DOI: 10.1001/jamaoncol.2017.3846] [Citation(s) in RCA: 123] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Importance There have been substantial improvements in the early detection, treatment, and survival from cancer in the United States, but it is not clear to what extent patients with different types of health insurance have benefitted from these advancements. Objective To examine trends in cancer survival by health insurance status from January 1997 to December 2014. Design, Setting, and Participants California Cancer Registry (a statewide cancer surveillance system) data were used to estimate population-based survival by health insurance status in 3 calendar periods: January 1997 to December 2002, January 2003 to December 2008, and January 2009 to December 2014 with follow-up through 2014. Overall, 1 149 891 patients diagnosed with breast, prostate, colorectal, or lung cancer, or melanoma in California were included in the study. Main Outcomes and Measures Five-year all-cause and cancer-specific survival probabilities by insurance category and calendar period for each cancer site and sex; hazard ratios (HRs) and 95% CIs for each insurance category (none, Medicare, other public) compared with private insurance in each calendar period. Results According to data from 1 149 891 patients diagnosed with breast, prostate, colorectal, or lung cancer, or melanoma gathered from the California Cancer Registry, improvements in survival were almost exclusively limited to patients with private or Medicare insurance. For patients with other public or no insurance, survival was largely unchanged or declined. Relative to privately insured patients, cancer-specific mortality was higher in uninsured patients for all cancers except prostate, and disparities were largest from 2009 to 2014 for breast (HR, 1.72; 95% CI, 1.45-2.03), lung (men: HR, 1.18; 95% CI, 1.06-1.31 and women: HR, 1.32; 95% CI, 1.15-1.50), and colorectal cancer (women: HR, 1.30; 95% CI, 1.05-1.62). Mortality was also higher for patients with other public insurance for all cancers except lung, and disparities were largest from 2009 to 2014 for breast (HR, 1.25; 95% CI, 1.17-1.34), prostate (HR, 1.17; 95% CI, 1.04-1.31), and colorectal cancer (men: HR, 1.16; 95% CI, 1.08-1.23 and women: HR, 1.11; 95% CI, 1.03-1.20). Conclusions and Relevance After accounting for patient and clinical characteristics, survival disparities for men with prostate cancer and women with lung or colorectal cancer increased significantly over time, reflecting a lack of improvement in survival for patients with other public or no insurance. To mitigate these growing disparities, all patients with cancer need access to health insurance that covers all the necessary elements of health care, from prevention and early detection to timely treatment according to clinical guidelines.
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Affiliation(s)
- Libby Ellis
- Cancer Prevention Institute of California, Fremont.,Stanford Cancer Institute, Stanford, California
| | | | - David Spiegel
- Stanford Cancer Institute, Stanford, California.,Stanford University School of Medicine, Stanford, California
| | - Uri Ladabaum
- Stanford Cancer Institute, Stanford, California.,Stanford University School of Medicine, Stanford, California
| | - Robert Haile
- Cedars-Sinai Medical Center, Los Angeles, California
| | - Scarlett Lin Gomez
- Cancer Prevention Institute of California, Fremont.,University of California, San Francisco, San Francisco
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22
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Jain V, Venigalla S, Sebro RA, Karakousis GC, Wilson RJ, Weber KL, Shabason JE. Association of health insurance status with presentation, treatment and outcomes in soft tissue sarcoma. Cancer Med 2019; 8:6295-6304. [PMID: 31483578 PMCID: PMC6797574 DOI: 10.1002/cam4.2441] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 05/23/2019] [Accepted: 07/08/2019] [Indexed: 12/18/2022] Open
Abstract
Background Numerous studies across a variety of malignancies have demonstrated that health insurance status is associated with differences in clinical presentation, type of treatments received, and survival. The effect of insurance status on the management of soft tissue sarcoma is unknown. We assessed the association of insurance on (a) stage at diagnosis, (b) receipt of neoadjuvant/adjuvant radiation therapy, and (c) overall survival (OS) in patients with soft tissue sarcoma. Methods The study cohort was identified from the National Cancer Database (NCDB) and consisted of patients with stage I‐IV soft tissue sarcoma of various histologies diagnosed from 2004 to 2015. The patients were stratified by age (<65 and ≥65 years) and by insurance status (commercial, Medicare, Medicaid and uninsured). Using multivariable logistic regression analysis, we evaluated the association between insurance status and (a) stage at diagnosis (Stage I‐III vs IV), and (b) receipt of neoadjuvant/adjuvant radiation therapy in patients with locally advanced disease. The association of insurance status on OS was assessed using Kaplan‐Meier and multivariable Cox proportional hazards analyses. A propensity score matched survival analysis was performed to account for measured confounders. Results 49 754 patients were identified of whom 23 677 (48%) had commercial insurance, 20 867 (42%) had Medicare, 3229 (6%) had Medicaid, and 1981 (4%) were uninsured. In patients <65 years, those with Medicaid (OR = 1.74, 95% CI: 1.57‐1.93, P < .001) and the uninsured (OR = 1.71, 95% CI: 1.51‐1.94, P < .001) were more likely to present with stage IV vs Stage I‐III disease. Furthermore, among patients with locally advanced disease treated with limb sparing surgery, those with Medicaid (OR = 0.87, 95% CI: 0.77‐ 0.98, P = .021) and the uninsured (OR = 0.73, 95% CI: 0.63‐0.85, P < .001) were less likely to receive neoadjuvant or adjuvant radiotherapy as compared to those with commercial insurance. Lastly, having Medicaid (HR = 1.26, 95% CI: 1.17‐1.34, P < .001) and no insurance (HR = 1.30, 95% CI: 1.20‐1.41, P < .001) was associated with worse OS compared to having commercial insurance, a finding which remained significant after propensity score matching. In contrast, in patients ≥65 years, there were no statistically significant differences between those with Medicare and commercial insurance with regards to disease presentation, receipt of radiotherapy, or survival. Conclusions In a large modern cohort identified from the NCDB, commercial insurance status in patients <65 years was associated early diagnosis, receipt of neoadjuvant/adjuvant radiation therapy, and overall survival for patients with soft tissue sarcoma. Further efforts are warranted to understand disparities in care based on health insurance in the United States.
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Affiliation(s)
- Varsha Jain
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Sriram Venigalla
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ronnie A Sebro
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Giorgos C Karakousis
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Robert J Wilson
- Department of Orthopedic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Kristy L Weber
- Department of Orthopedic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jacob E Shabason
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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23
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Lebo NL, Khalil D, Balram A, Holland M, Corsten M, Ted McDonald J, Johnson-Obaseki S. Influence of Socioeconomic Status on Stage at Presentation of Laryngeal Cancer in the United States. Otolaryngol Head Neck Surg 2019; 161:800-806. [DOI: 10.1177/0194599819856305] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Identify socioeconomic predictors of stage at diagnosis of laryngeal cancer in the United States. Study Design Retrospective analysis of the North American Association of Central Cancer Registries’ Incidence Data–Cancers in North America Deluxe Analytic File for expanded races. Setting All centers reporting to the US Centers for Disease Control and Prevention’s National Program of Cancer Registries. Subjects and Methods All cases of laryngeal cancer in adult patients from 2005 to 2013 were reviewed. Ordinal logistic regression models were used to evaluate odd ratios (ORs) for socioeconomic indicators potentially predictive of advancing American Joint Committee on Cancer stage at diagnosis. Results A total of 72,472 patients were identified and included. Analysis revealed significant correlation between advanced stage at diagnosis and: Medicaid insurance, lack of insurance, female sex, older age, black race, and certain states of residence. The strongest predictor of advanced stage was lack of insurance (OR, 2.212; P < .001; 95% CI, 2.035-2.406). The strongest protective factor was residing in the state of Utah (OR, 0.571; P < .001; 95% CI, 0.536-0.609). Once adjusted for regional price and wage disparities, relative income was not a significant predictor of stage at presentation across multiple analyses. Conclusion Multiple socioeconomic factors were predictive of severity of disease at presentation of laryngeal cancer in the United States. This study demonstrated that insurance type was strongly predictive, whereas relative income had surprisingly little influence.
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Affiliation(s)
- Nicole L. Lebo
- Department of Otolaryngology–Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Diana Khalil
- Department of Otolaryngology–Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Adele Balram
- New Brunswick Institute for Research, Data, and Training, Fredericton, New Brunswick, Canada
| | - Margaret Holland
- New Brunswick Institute for Research, Data, and Training, Fredericton, New Brunswick, Canada
| | - Martin Corsten
- Division of Otolaryngology–Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - James Ted McDonald
- Department of Economics, University of New Brunswick, Fredericton, New Brunswick, Canada
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24
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Gallaway MS, Huang B, Chen Q, Tucker T, McDowell J, Durbin E, Siegel D, Tai E. Identifying Smoking Status and Smoking Cessation Using a Data Linkage Between the Kentucky Cancer Registry and Health Claims Data. JCO Clin Cancer Inform 2019; 3:1-8. [PMID: 31095418 DOI: 10.1200/cci.19.00011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Linkage of cancer registry data with complementary data sources can be an informative way to expand what is known about patients and their treatment and improve delivery of care. The purpose of this study was to explore whether patient smoking status and smoking-cessation modalities data in the Kentucky Cancer Registry (KCR) could be augmented by linkage with health claims data. METHODS The KCR conducted a data linkage with health claims data from Medicare, Medicaid, state employee insurance, Humana, and Anthem. Smoking status was defined as documentation of personal history of tobacco use (International Classification of Diseases, Ninth Revision [ICD-9] code V15.82) or tobacco use disorder (ICD-9 305.1) before and after a cancer diagnosis. Use of smoking-cessation treatments before and after the cancer diagnosis was defined as documentation of smoking-cessation counseling (Healthcare Common Procedure Coding System codes 99406, 99407, G0375, and G0376) or pharmacotherapy (eg, nicotine replacement therapy, bupropion, varenicline). RESULTS From 2007 to 2011, among 23,703 patients in the KCR, we discerned a valid prediagnosis smoking status for 78%. KCR data only (72%), claims data only (6%), and a combination of both data sources (22%) were used to determine valid smoking status. Approximately 4% of patients with cancer identified as smokers (n = 11,968) and were provided smoking-cessation counseling, and 3% were prescribed pharmacotherapy for smoking cessation. CONCLUSION Augmenting KCR data with medical claims data increased capture of smoking status and use of smoking-cessation modalities. Cancer registries interested in exploring smoking status to influence treatment and research activities could consider a similar approach, particularly if their registry does not capture smoking status for a majority of patients.
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Affiliation(s)
| | - Bin Huang
- University of Kentucky, Lexington, KY
| | - Quan Chen
- University of Kentucky, Lexington, KY
| | | | | | | | - David Siegel
- Centers for Disease Control and Prevention, Atlanta, GA
| | - Eric Tai
- Centers for Disease Control and Prevention, Atlanta, GA
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25
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Maguire FB, Morris CR, Parikh-Patel A, Cress RD, Keegan THM, Li CS, Lin PS, Kizer KW. Disparities in Systemic Treatment Use in Advanced-stage Non-Small Cell Lung Cancer by Source of Health Insurance. Cancer Epidemiol Biomarkers Prev 2019; 28:1059-1066. [PMID: 30842132 DOI: 10.1158/1055-9965.epi-18-0823] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/26/2018] [Accepted: 03/01/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Management of advanced-stage non-small cell lung cancer (NSCLC) has changed significantly over the past two decades with the development of numerous systemic treatments, including targeted therapies. However, a high proportion of advanced-stage patients are untreated. The role that health insurance plays in receipt of systemic treatments is unclear. METHODS Using California Cancer Registry data (2012-2014), we developed multivariable Poisson regression models to assess the independent effect of health insurance type on systemic treatment utilization among patients with stage IV NSCLC. Systemic treatment information was manually abstracted from treatment text fields. RESULTS A total of 17,310 patients were evaluated. Patients with Medicaid/other public insurance were significantly less likely to receive any systemic treatments [risk ratio (RR), 0.78; 95% confidence interval (CI), 0.75-0.82], bevacizumab combinations (RR, 0.57; 95% CI, 0.45-0.71), or tyrosine kinase inhibitors (RR, 0.70; 95% CI, 0.60-0.82) compared with the privately insured. Patients with Medicare or dual Medicare-Medicaid insurance were not significantly different from the privately insured in their likelihood of receiving systemic treatments. CONCLUSIONS Substantial disparities in the use of systemic treatments for stage IV NSCLC exist by source of health insurance in California. Patients with Medicaid/other public insurance were significantly less likely to receive systemic treatments compared with their privately insured counterparts. IMPACT Source of health insurance influences care received. Further research is warranted to better understand barriers to treatment that patients with Medicaid face.
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Affiliation(s)
- Frances B Maguire
- California Cancer Reporting and Epidemiologic Surveillance Program, Institute for Population Health Improvement, University of California Davis Health, Sacramento, California. .,Graduate Group in Epidemiology, University of California, Davis, Davis, California
| | - Cyllene R Morris
- California Cancer Reporting and Epidemiologic Surveillance Program, Institute for Population Health Improvement, University of California Davis Health, Sacramento, California
| | - Arti Parikh-Patel
- California Cancer Reporting and Epidemiologic Surveillance Program, Institute for Population Health Improvement, University of California Davis Health, Sacramento, California
| | - Rosemary D Cress
- Public Health Sciences, University of California, Davis, Davis, California
| | - Theresa H M Keegan
- Center for Oncology Hematology Outcomes Research and Training (COHORT) and Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, California
| | - Chin-Shang Li
- School of Nursing, The State University of New York, University at Buffalo, Buffalo, New York
| | - Patrick S Lin
- Center for Oncology Hematology Outcomes Research and Training (COHORT) and Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, California
| | - Kenneth W Kizer
- California Cancer Reporting and Epidemiologic Surveillance Program, Institute for Population Health Improvement, University of California Davis Health, Sacramento, California.,Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, California.,Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, California
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26
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Goldstein JS, Nastoupil LJ, Han X, Jemal A, Ward E, Flowers CR. Disparities in survival by insurance status in follicular lymphoma. Blood 2018; 132:1159-1166. [PMID: 30042094 PMCID: PMC6137560 DOI: 10.1182/blood-2018-03-839035] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 07/06/2018] [Indexed: 01/07/2023] Open
Abstract
Follicular lymphoma (FL) is the second most common non-Hodgkin lymphoma and most common indolent non-Hodgkin lymphoma. Lower socioeconomic status is associated with poor outcomes in FL, suggesting that access to care is an important prognostic factor; however, the association between insurance status and FL survival has not been sufficiently examined. The National Cancer Database, a nationwide cancer registry, was used to evaluate 43 648 patients with FL diagnosed between 2004 and 2014. All analyses were performed on 2 cohorts segmented at age 65 years to account for changes in insurance status with Medicare eligibility. Cox proportional hazard models calculated hazard ratios (HRs) with confidence intervals (CIs) for the association between insurance status and overall survival (OS) controlling for the available sociodemographic and prognostic factors. Kaplan-Meier curves display outcomes by insurance status for patients covered by private insurance, no insurance, Medicaid, or Medicare. When compared with patients younger than age 65 years with private insurance, patients younger than age 65 years with no insurance (HR, 1.96; 95% CI, 1.69-2.28), with Medicaid (HR, 1.82; 95% CI, 1.57-2.12), and with Medicare (HR, 1.96; 95% CI, 1.71-2.24) had significantly worse OS after adjusting for sociodemographic and prognostic factors. Compared with patients age 65 years or older with private insurance, those with Medicare only (HR, 1.28; 95% CI, 1.17-1.4) had significantly worse OS. For adults with FL, expanding access to care through insurance has the potential to improve outcomes.
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27
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Li X, Zhou Q, Wang X, Su S, Zhang M, Jiang H, Wang J, Liu M. The effect of low insurance reimbursement on quality of care for non-small cell lung cancer in China: a comprehensive study covering diagnosis, treatment, and outcomes. BMC Cancer 2018; 18:683. [PMID: 29940893 PMCID: PMC6019825 DOI: 10.1186/s12885-018-4608-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 06/18/2018] [Indexed: 11/10/2022] Open
Abstract
Background The insurance reimbursement rate of medical cost affects the quality and quantity of health services provided in China. The nature of this relationship, however, has not been reliably described in the field of non-small cell lung cancer (NSCLC). The objective of the current study was to examine the impact of low reimbursement rates of medical costs on diagnosis, treatment and outcomes among patients with NSCLC. Methods We examined care of 2643 NSCLC patients and we divided the study cohort into a high reimbursement rate group and a low reimbursement rate group. The impact of reimbursement rates of medical costs on quality of care of NSCLC patients were examined using logistic regression and generalized linear models. Results Compared with patients insured with high reimbursement rate, patients insured through lower reimbursement rate programs were less likely to benefit from early detection and treatment services. Delayed detection was more common in low reimbursement group and they were less likely to be recommended for adjuvant chemotherapy, or to receive adjuvant chemotherapy and postoperative radiation therapy and they had lower odds to receipt chemotherapy response assessment. However, low reimbursement rate group had lower rate of in-hospital mortality and metastases. Conclusions Low reimbursement rate mainly negatively influenced the diagnosis and treatment of NSCLC. Reducing the gap in reimbursement rate between the three health insurance schemes should be a focus of equalizing access to care and improving the level of medical compliance and finally improving quality of care of NSCLC. Electronic supplementary material The online version of this article (10.1186/s12885-018-4608-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xi Li
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, China
| | - Qi Zhou
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, China
| | - Xinyu Wang
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, China
| | - Shaofei Su
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, China
| | - Meiqi Zhang
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, China
| | - Hao Jiang
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, China
| | - Jiaying Wang
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, China
| | - Meina Liu
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, China. .,School of Public Health, Harbin Medical University, No.157 Baojian Road, Harbin, 150081, China.
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28
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Nikpay SS, Tebbs MG, Castellanos EH. Patient Protection and Affordable Care Act Medicaid expansion and gains in health insurance coverage and access among cancer survivors. Cancer 2018; 124:2645-2652. [PMID: 29663343 DOI: 10.1002/cncr.31288] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 11/21/2017] [Accepted: 11/22/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND The Patient Protection and Affordable Care Act extends Medicaid coverage to millions of low-income adults, including many survivors of cancer who were unable to purchase affordable health insurance coverage in the individual health insurance market. METHODS Using data from the 2011 to 2015 Behavioral Risk Factor Surveillance System, the authors compared changes in coverage and health care access measures for low-income cancer survivors in states that did and did not expand Medicaid. RESULTS The study population of 17,381 individuals included adults aged 18 to 64 years, and was predominantly female, white, and unmarried. The authors found a relative reduction in the uninsured rate of 11.7 percentage points and a relative increase in the probability of having a personal physician of 5.8 percentage points. Stratifying by whether states expanded Medicaid by 2015, the authors found that relative gains in coverage and access were larger among those individuals residing in states with expanded Medicaid compared with those residing in nonexpansion states. CONCLUSIONS The results of the current study suggest that the Patient Protection and Affordable Care Act Medicaid expansion has improved coverage and access for cancer survivors. Cancer 2018;124:2645-52. © 2018 American Cancer Society.
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Affiliation(s)
- Sayeh S Nikpay
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Margaret G Tebbs
- School of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Emily H Castellanos
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
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29
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Tantraworasin A, Taioli E, Liu B, Flores RM, Kaufman AJ. The influence of insurance type on stage at presentation, treatment, and survival between Asian American and non-Hispanic White lung cancer patients. Cancer Med 2018; 7:1612-1629. [PMID: 29575647 PMCID: PMC5943464 DOI: 10.1002/cam4.1331] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 12/08/2017] [Accepted: 12/15/2017] [Indexed: 12/19/2022] Open
Abstract
The effect of insurance type on lung cancer diagnosis, treatment, and survival in Asian patients living in the United States is still under debate. We have analyzed this issue using the Surveillance, Epidemiology, and End Results database. There were 102,733 lung cancer patients age 18–64 years diagnosed between 2007 and 2013. Multilevel regression analysis was performed to identify the association between insurance types, stage at diagnosis, treatment modalities, and overall mortality in Asian and non‐Hispanic White (NHW) patients. Clinical characteristics were significantly different between Asian and NHW patients, except for gender. Asian patients were more likely to present with advanced disease than NHW patients (ORadj = 1.12, 95% CI = 1.06–1.19). Asian patients with non‐Medicaid insurance underwent lobectomy more than NHW patients with Medicaid or uninsured; were more likely to undergo mediastinal lymph node evaluation (MLNE) (ORadj = 1.98, 95% CI = 1.72–2.28) and cancer‐directed surgery and/or radiation therapy (ORadj = 1.41, 95% CI = 1.20–1.65). Asian patients with non‐Medicaid insurance had the best overall survival. Uninsured or Medicaid‐covered Asian patients were more likely to be diagnosed with advanced disease, less likely to undergo MLNE and cancer‐directed treatments, and had shorter overall survival than their NHW counterpart.
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Affiliation(s)
- Apichat Tantraworasin
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1023 Annenberg Building, 7-56, New York City, 10029, New York.,Department of Surgery, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Chiang Mai, 50200, Thailand.,Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, 239 Suthep Road, Chiang Mai, 50200, Thailand
| | - Emanuela Taioli
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1023 Annenberg Building, 7-56, New York City, 10029, New York.,Department of Population Health Science and Policy and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1133, New York City, 10029, New York
| | - Bian Liu
- Department of Population Health Science and Policy and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1133, New York City, 10029, New York
| | - Raja M Flores
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1023 Annenberg Building, 7-56, New York City, 10029, New York
| | - Andrew J Kaufman
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1023 Annenberg Building, 7-56, New York City, 10029, New York
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30
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Impact of Insurance Coverage on Outcomes in Primary Breast Sarcoma. Sarcoma 2018; 2018:4626174. [PMID: 29736143 PMCID: PMC5875066 DOI: 10.1155/2018/4626174] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 12/06/2017] [Accepted: 12/17/2017] [Indexed: 11/17/2022] Open
Abstract
Private insurance is associated with better outcomes in multiple common cancers. We hypothesized that insurance status would significantly impact outcomes in primary breast sarcoma (PBS) due to the additional challenges of diagnosing and coordinating specialized care for a rare cancer. Using the National Cancer Database, we identified adult females diagnosed with PBS between 2004 and 2013. The influence of insurance status on overall survival (OS) was evaluated using the Kaplan-Meier estimator with log-rank tests and Cox proportional hazard models. Among a cohort of 607 patients, 67 (11.0%) had Medicaid, 217 (35.7%) had Medicare, and 323 (53.2%) had private insurance. Compared to privately insured patients, Medicaid patients were more likely to present with larger tumors and have their first surgical procedure further after diagnosis. Treatment was similar between patients with comparable disease stage. In multivariate analysis, Medicaid (hazard ratio (HR), 2.47; 95% confidence interval (CI), 1.62-3.77; p < 0.001) and Medicare (HR, 1.68; 95% CI, 1.10-2.57; p=0.017) were independently associated with worse OS. Medicaid insurance coverage negatively impacted survival compared to private insurance more in breast sarcoma than in breast carcinoma (interaction p < 0.001). In conclusion, patients with Medicaid insurance present with later stage disease and have worse overall survival than privately insured patients with PBS. Worse outcomes for Medicaid patients are exacerbated in this rare cancer.
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31
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Eberth JM, Thibault A, Caldwell R, Josey MJ, Qiang B, Peña E, LaFrance D, Berger FG. A statewide program providing colorectal cancer screening to the uninsured of South Carolina. Cancer 2018; 124:1912-1920. [PMID: 29415338 DOI: 10.1002/cncr.31250] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 12/01/2017] [Accepted: 12/27/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cancer screening rates are lowest in those without insurance or a regular provider. Since 2008, the Colorectal Cancer Prevention Network (CCPN) has provided open access colonoscopy to uninsured residents of South Carolina through established, statewide partnerships and patient navigation. Herein, we describe the structure, implementation, and clinical outcomes of this program. METHODS The CCPN provides access to colonoscopy screening at no cost to uninsured, asymptomatic patients aged 50-64 years (African Americans age 45-64 years are eligible) who live at or below 150% of the poverty line and seek medical care in free medical clinics, federally qualified health centers, or hospital-based indigent practices in South Carolina. Screening is performed by board-certified gastroenterologists. Descriptive statistics and regression analysis are used to describe the population screened, and to assess compliance rates and colonoscopy quality metrics. RESULTS Out of >4000 patients referred to the program, 1854 were deemed eligible, 1144 attended an in-person navigation visit, and 1030 completed a colonoscopy; 909 were included in the final sample. Nearly 90% of participants exhibited good-to-excellent bowel preparation. An overall cecal intubation rate of 99% was measured. The polyp detection rate and adenoma detection rate were 63% and 36%, respectively, with male sex and urban residence positively associated with adenoma detection. Over 13% of participants had an advanced polyp, and 1% had a cancer diagnosis or surgical intervention. CONCLUSION The CCPN program is characterized by strong collaboration with clinicians statewide, low no-show rates, and high colonoscopy quality. Future work will assess the effectiveness of the navigation approach and will explore the mechanisms driving higher adenoma detection in urban participants. Cancer 2018;124:1912-20. © 2018 American Cancer Society.
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Affiliation(s)
- Jan M Eberth
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina.,Cancer Prevention and Control Program, University of South Carolina, Columbia, South Carolina.,South Carolina Rural Health Research Center, University of South Carolina, Columbia, South Carolina.,Center for Colon Cancer Research, University of South Carolina, Columbia, South Carolina
| | - Annie Thibault
- Center for Colon Cancer Research, University of South Carolina, Columbia, South Carolina
| | - Renay Caldwell
- Center for Colon Cancer Research, University of South Carolina, Columbia, South Carolina
| | - Michele J Josey
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina
| | - Beidi Qiang
- Department of Statistics, University of South Carolina, Columbia, South Carolina.,Department of Mathematics and Statistics, Southern Illinois University, Edwardsville, Illinois
| | - Edsel Peña
- Department of Statistics, University of South Carolina, Columbia, South Carolina
| | | | - Franklin G Berger
- Center for Colon Cancer Research, University of South Carolina, Columbia, South Carolina.,Department of Biological Sciences, University of South Carolina, Columbia, South Carolina
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32
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Parikh-Patel A, Morris CR, Kizer KW. Disparities in quality of cancer care: The role of health insurance and population demographics. Medicine (Baltimore) 2017; 96:e9125. [PMID: 29390313 PMCID: PMC5815725 DOI: 10.1097/md.0000000000009125] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Escalating costs and concerns about quality of cancer care have increased calls for quality measurement and performance accountability for providers and health plans. The purpose of the present cross-sectional study was to assess variability in the quality of cancer care by health insurance type in California.Persons with breast, ovary, endometrium, cervix, colon, lung, or gastric cancer during the period 2004 to 2014 were identified in the California Cancer Registry. Individuals were stratified into 5 health insurance categories: private insurance, Medicare, Medicaid, dual Medicare and Medicaid eligible, and uninsured. Quality of care was evaluated using Commission on Cancer quality measures. Logistic regression models were generated to assess the independent effect of health insurance type on stage at diagnosis, quality of care and survival after adjusting for age, sex, race/ethnicity, and socioeconomic status (SES).A total of 763,884 cancer cases were evaluated. Individuals with Medicaid or Medicare-Medicaid dual-eligible coverage and the uninsured had significantly lower odds of receiving recommended radiation and/or chemotherapy after diagnosis or surgery for breast, endometrial, and colon cancer, relative to those with private insurance. Dual eligible patients with gastric cancer had 21% lower odds of having the recommended number of lymph nodes removed and examined compared to privately insured patients.After adjusting for known demographic confounders, substantial and consistent disparities in quality of cancer care exist according to type of health insurance in California. Further study is needed to identify particular factors and mechanisms underlying the identified treatment disparities across sources of health insurance.
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Affiliation(s)
- Arti Parikh-Patel
- California Cancer Reporting and Epidemiologic Surveillance (CalCARES) Program, Institute for Population Health Improvement, University of California Davis Health
| | - Cyllene R. Morris
- California Cancer Reporting and Epidemiologic Surveillance (CalCARES) Program, Institute for Population Health Improvement, University of California Davis Health
| | - Kenneth W. Kizer
- California Cancer Reporting and Epidemiologic Surveillance (CalCARES) Program, Institute for Population Health Improvement, University of California Davis Health
- University of California, Davis, School of Medicine and Betty Irene Moore School of Nursing, Sacramento, CA, USA
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Rohlfing ML, Mays AC, Isom S, Waltonen JD. Insurance status as a predictor of mortality in patients undergoing head and neck cancer surgery. Laryngoscope 2017. [PMID: 28639701 DOI: 10.1002/lary.26713] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Explore relationship between insurance status and survival, determine outcomes that vary based on insurance status, and identify potential areas of intervention. STUDY DESIGN Retrospective cohort analysis of patients who underwent resection of an upper aerodigestive tract malignancy at a single tertiary care hospital during a 5-year period. METHODS Patients were categorized into four groups by insurance status: Medicaid or uninsured, Medicare and under 65 years of age, Medicare and 65 years or older, and private insurance. Data were collected from the medical record and analyzed with respect to survival and other outcomes. RESULTS The final cohort consisted of 860 patients. Survival analysis demonstrated a hazard ratio of 2.1 (95% confidence interval [CI], 1.5-3.0) for the Medicaid/uninsured group when compared to the private insurance group. When adjusted for other variables, mortality was still different across insurance groups (P = 0.002). The following also were different across insurance groups: tumor stage (P < 0.001), American Society of Anesthesiologists score (P < 0.001), length of stay (P < 0.001), and complications (P = 0.021). The Medicaid/uninsured group was most likely to have a complication (odds ratio [OR] = 2.10, 95% CI 1.24-3.56, P = 0.006). CONCLUSION Medicaid/uninsured patients present with more advanced tumors and have poorer survival than privately insured patients. Insurance status is predictive of tumor stage, comorbidity burden, length of stay, and complications. Specifically, the Medicaid/uninsured group had high rates of tobacco use and alcohol abuse, advanced stage tumors, and postoperative complications. Because alcohol abuse and advanced stage also were predictors of poor survival, they may contribute to the survival disparity for socially disadvantaged patients. LEVEL OF EVIDENCE 4. Laryngoscope, 127:2784-2789, 2017.
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Affiliation(s)
- Matthew L Rohlfing
- Department of Otolaryngology, Boston Medical Center, Boston, Massachusetts
| | - Ashley C Mays
- Department of Otolaryngology, MD Anderson Cancer Center, Houston, Texas
| | - Scott Isom
- Department of Biostatistical Sciences, Comprehensive Cancer Center, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Joshua D Waltonen
- Department of Otolaryngology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
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34
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Koroukian SM, Bakaki PM, Htoo PT, Han X, Schluchter M, Owusu C, Cooper GS, Rose J, Flocke SA. The Breast and Cervical Cancer Early Detection Program, Medicaid, and breast cancer outcomes among Ohio's underserved women. Cancer 2017; 123:3097-3106. [PMID: 28542870 DOI: 10.1002/cncr.30720] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/01/2017] [Accepted: 03/16/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND As an organized screening program, the national Breast and Cervical Cancer Early Detection Program (BCCEDP) was launched in the early 1990s to improve breast cancer outcomes among underserved women. To analyze the impact of the BCCEDP on breast cancer outcomes in Ohio, this study compared cancer stages and mortality across BCCEDP participants, Medicaid beneficiaries, and "all others." METHODS This study linked data across the Ohio Cancer Incidence Surveillance System, Medicaid, the BCCEDP database, death certificates, and the US Census and identified 26,426 women aged 40 to 64 years who had been diagnosed with incident invasive breast cancer during the years 2002-2008 (deaths through 2010). The study groups were as follows: BCCEDP participants (1-time or repeat users), Medicaid beneficiaries (women enrolled in Medicaid before their cancer diagnosis [Medicaid/prediagnosis] or around the time of their cancer diagnosis [Medicaid/peridiagnosis]), and all others (women identified as neither BCCEDP participants nor Medicaid beneficiaries). The outcomes included advanced-stage cancer at diagnosis and mortality. A multivariable logistic and survival analysis was conducted to examine the independent association between the BCCEDP and Medicaid status and the outcomes. RESULTS The percentage of women presenting with advanced-stage disease was highest among women in the Medicaid/peridiagnosis group (63.4%) and lowest among BCCEDP repeat users (38.6%). With adjustments for potential confounders and even in comparison with Medicaid/prediagnosis beneficiaries, those in the Medicaid/peridiagnosis group were twice as likely to be diagnosed with advanced-stage disease (adjusted odds ratio, 2.20; 95% confidence interval, 1.83-2.66). CONCLUSIONS Medicaid/peridiagnosis women are at particularly high risk to be diagnosed with advanced-stage disease. Efforts to reduce breast cancer disparities must target this group of women before they present to Medicaid. Cancer 2017;123:3097-106. © 2017 American Cancer Society.
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Affiliation(s)
- Siran M Koroukian
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio.,Case Comprehensive Cancer Center, Cleveland, Ohio.,Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Case Western Reserve University, Cleveland, Ohio
| | - Paul M Bakaki
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio.,Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Case Western Reserve University, Cleveland, Ohio
| | - Phyo Than Htoo
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio.,Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Case Western Reserve University, Cleveland, Ohio
| | - Xiaozhen Han
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio.,Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Case Western Reserve University, Cleveland, Ohio
| | - Mark Schluchter
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio.,Case Comprehensive Cancer Center, Cleveland, Ohio
| | - Cynthia Owusu
- Case Comprehensive Cancer Center, Cleveland, Ohio.,Department of Medicine, University Hospitals of Cleveland, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Gregory S Cooper
- Case Comprehensive Cancer Center, Cleveland, Ohio.,Department of Medicine, University Hospitals of Cleveland, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Johnie Rose
- Case Comprehensive Cancer Center, Cleveland, Ohio.,Department of Family and Community Health, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Susan A Flocke
- Case Comprehensive Cancer Center, Cleveland, Ohio.,Department of Family and Community Health, School of Medicine, Case Western Reserve University, Cleveland, Ohio
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Herget K, Stroup A, Smith K, Wen M, Sweeney C. Unstaged cancer: Long-term decline in incidence by site and by demographic and socioeconomic characteristics. Cancer Causes Control 2017; 28:341-349. [DOI: 10.1007/s10552-017-0874-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 02/16/2017] [Indexed: 12/14/2022]
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Lipscomb J, Fleming ST, Trentham-Dietz A, Kimmick G, Wu XC, Morris CR, Zhang K, Smith RA, Anderson RT, Sabatino SA. What Predicts an Advanced-Stage Diagnosis of Breast Cancer? Sorting Out the Influence of Method of Detection, Access to Care, and Biologic Factors. Cancer Epidemiol Biomarkers Prev 2016; 25:613-23. [PMID: 26819266 DOI: 10.1158/1055-9965.epi-15-0225] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 12/11/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Multiple studies have yielded important findings regarding the determinants of an advanced-stage diagnosis of breast cancer. We seek to advance this line of inquiry through a broadened conceptual framework and accompanying statistical modeling strategy that recognize the dual importance of access-to-care and biologic factors on stage. METHODS The Centers for Disease Control and Prevention-sponsored Breast and Prostate Cancer Data Quality and Patterns of Care Study yielded a seven-state, cancer registry-derived population-based sample of 9,142 women diagnosed with a first primary in situ or invasive breast cancer in 2004. The likelihood of advanced-stage cancer (American Joint Committee on Cancer IIIB, IIIC, or IV) was investigated through multivariable regression modeling, with base-case analyses using the method of instrumental variables (IV) to detect and correct for possible selection bias. The robustness of base-case findings was examined through extensive sensitivity analyses. RESULTS Advanced-stage disease was negatively associated with detection by mammography (P < 0.001) and with age < 50 (P < 0.001), and positively related to black race (P = 0.07), not being privately insured [Medicaid (P = 0.01), Medicare (P = 0.04), uninsured (P = 0.07)], being single (P = 0.06), body mass index > 40 (P = 0.001), a HER2 type tumor (P < 0.001), and tumor grade not well differentiated (P < 0.001). This IV model detected and adjusted for significant selection effects associated with method of detection (P = 0.02). Sensitivity analyses generally supported these base-case results. CONCLUSIONS Through our comprehensive modeling strategy and sensitivity analyses, we provide new estimates of the magnitude and robustness of the determinants of advanced-stage breast cancer. IMPACT Statistical approaches frequently used to address observational data biases in treatment-outcome studies can be applied similarly in analyses of the determinants of stage at diagnosis. Cancer Epidemiol Biomarkers Prev; 25(4); 613-23. ©2016 AACR.
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Affiliation(s)
- Joseph Lipscomb
- Department of Health Policy and Management, Rollins School of Public Health, Winship Cancer Institute, Emory University, Atlanta, Georgia.
| | - Steven T Fleming
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, Kentucky
| | | | - Gretchen Kimmick
- Department of Internal Medicine, Medical Oncology, Duke University Medical Center and Multidisciplinary Breast Cancer Program, Duke Cancer Institute, Durham, North Carolina
| | - Xiao-Cheng Wu
- Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Cyllene R Morris
- California Cancer Registry, Institute for Population Health Improvement, UC Davis Health System, Sacramento, California
| | - Kun Zhang
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - Roger T Anderson
- Department of Public Health Sciences, University of Virginia School of Medicine, and UVA Cancer Center, Charlottesville, Virginia
| | - Susan A Sabatino
- Division of Cancer Prevention and Control, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
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Koroukian SM, Bakaki PM, Schluchter M, Owusu C, Cooper GS, Flocke SA. Comparing Breast Cancer Outcomes Between Medicaid and the Ohio Breast and Cervical Cancer Early Detection Program. J Oncol Pract 2015; 11:478-85. [PMID: 26374859 DOI: 10.1200/jop.2014.002634] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To compare outcomes between women enrolling in Medicaid after being diagnosed with breast cancer and those referred to Medicaid through the Ohio Breast and Cervical Cancer Early Detection Program (BCCEDP). METHODS Using linked data from the 2002 to 2008 Ohio Cancer Incidence Surveillance System, Medicaid, the BCCEDP database, and Ohio death certificates (through 2010), we identified women 40 to 64 years of age diagnosed with incident invasive breast cancer during the study years and enrolled in Medicaid 3 months before or after cancer diagnosis. We compared the following outcomes across BCCEDP one-time and repeat participants and nonparticipants: (1) cancer stage at diagnosis, (2) treatment delays, (3) receipt of standard treatment, and (4) survival. We conducted multivariable logistic regression and survival analysis to examine the association between BCCEDP participation and the outcomes of interest, controlling for potential confounders. RESULTS We identified 427 and 654 BCCEDP participants and nonparticipants, respectively; 28.5% of BCCEDP women were repeat participants. Compared with nonparticipants, BCCEDP one-time and repeat participants were significantly less likely to be diagnosed with advanced-stage cancer (one-time: adjusted odds ratio [AOR], 0.64; 95% CI, 0.49 to 0.85; repeat: AOR, 0.34; 95% CI, 0.23 to 0.52), or experience delays in treatment initiation (one-time: adjusted hazard ratio [AHR], 1.29; 95% CI, 1.09 to 1.51; repeat: AHR, 1.38; 95% CI, 1.11 to 1.72). In addition, although we observed no difference in receipt of standard cancer treatment, BCCEDP participants experienced cancer-specific and overall survival benefits. CONCLUSION Compared with nonparticipants, BCCEDP participants experienced earlier breast cancer stage at diagnosis, shorter time to treatment initiation, and survival benefits.
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Affiliation(s)
- Siran M Koroukian
- Case Western Reserve University; Case Comprehensive Cancer Center, Case Western Reserve University; University Hospitals of Cleveland; and Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Cleveland, OH
| | - Paul M Bakaki
- Case Western Reserve University; Case Comprehensive Cancer Center, Case Western Reserve University; University Hospitals of Cleveland; and Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Cleveland, OH
| | - Mark Schluchter
- Case Western Reserve University; Case Comprehensive Cancer Center, Case Western Reserve University; University Hospitals of Cleveland; and Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Cleveland, OH
| | - Cynthia Owusu
- Case Western Reserve University; Case Comprehensive Cancer Center, Case Western Reserve University; University Hospitals of Cleveland; and Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Cleveland, OH
| | - Gregory S Cooper
- Case Western Reserve University; Case Comprehensive Cancer Center, Case Western Reserve University; University Hospitals of Cleveland; and Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Cleveland, OH
| | - Susan A Flocke
- Case Western Reserve University; Case Comprehensive Cancer Center, Case Western Reserve University; University Hospitals of Cleveland; and Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Cleveland, OH
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Variation in Intensity and Costs of Care by Payer and Race for Patients Dying of Cancer in Texas: An Analysis of Registry-linked Medicaid, Medicare, and Dually Eligible Claims Data. Med Care 2015; 53:591-8. [PMID: 26067883 DOI: 10.1097/mlr.0000000000000369] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate end-of-life care for Medicaid, Medicare, and dually eligible beneficiaries dying of cancer in Texas. METHODS We analyzed the Texas Cancer Registry (TCR)-Medicaid and TCR-Medicare linked databases' claims data for 69,572 patients dying of cancer in Texas from 2000 to 2008. We conducted regression models in adjusted analyses of cancer-directed and acute care and total costs of care (in 2014 dollars) in the last 30 days of life. RESULTS Medicaid patients were more likely to receive chemotherapy and radiation therapy. Medicaid patients were more likely to have >1 emergency room (ER) [odds ratio (OR)=5.27; 95% confidence interval (CI), 4.76-5.84], and were less likely to enroll in hospice (OR=0.59; 95% CI, 0.55-0.63) than Medicare patients. Dual eligibles were more likely to have >1 ER visit than Medicare-only beneficiaries (OR=1.19; 95% CI, 1.07-1.33). Black and Hispanic patients were more likely to experience >1 ER visit and >1 hospitalization than whites. Costs were higher for nonwhite Medicare, Medicaid, and dually eligible patients compared with white Medicare enrollees. CONCLUSIONS Variation in acute care utilization and costs by race and payer suggest efforts are needed to address palliative care coordination at the end of life for Medicaid and dually eligible beneficiaries and minority patients dying of cancer.
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Hicks EM, Litwin MS, Maliski SL. Latino men and familial risk communication about prostate cancer. Oncol Nurs Forum 2015; 41:509-16. [PMID: 25158656 DOI: 10.1188/14.onf.509-516] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE/OBJECTIVES To investigate how familial communication about prostate cancer (PCa) risk and screening affects sons of men with PCa. RESEARCH APPROACH Qualitative grounded theory. SETTING Southern California. PARTICIPANTS 17 Latino sons of PCa survivors. METHODOLOGIC APPROACH The team conducted semistructured interviews and follow-up interviews. Therefore, the sample includes 25 transcripts. Data were analyzed with a mix of a priori topical codes and grounded theory techniques. FINDINGS Sons were in need of information about familial risk and screening options. They became sensitized to PCa, desired information, and held protective intentions. Hopeful intentions came up against cultural taboos around sex, reproductive health, and intimacy that limited discussions between fathers and sons. Fathers were a valued source of information but play various roles, which affect sons' screening intentions. Open communication between father and son promoted awareness of screening and familial risk. CONCLUSIONS Uncertainty about familial risk and screening options, especially early detection strategies, was exacerbated by cultural taboos around PCa. Fathers could have been primary and credible advocates for shared decision making, but sons had difficulty learning from their fathers' experience. INTERPRETATION FINDINGS from the study can help inform community-based interventions with Latino families, help to culturally tailor health messaging, and sensitize clinicians to a group that needs concerted counseling about PCa risk and screening.
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Affiliation(s)
| | - Mark S Litwin
- Department of Urology, University of California, Los Angeles
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Hooten KG, Neal D, Lovaton Espadin RE, Gil JN, Azari H, Rahman M. Insurance Status Influences the Rates of Reportable Quality Metrics in Brain Tumor Patients. Neurosurgery 2015; 76:239-47; discussion 247-8. [DOI: 10.1227/neu.0000000000000594] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Role of Socioeconomic Status in Predicting Sonographically Detected Breast Cancer Compared With Family History, Age, or Ethnicity. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2015. [DOI: 10.1177/8756479314563333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To determine if socioeconomic status is another risk factor in the development and treatment of breast cancer, the records of 250 women, equally divided between those with and without breast cancer, were studied at an outpatient clinic. The frequency of sonographically detected breast cancer increased systematically with respect to age, from 0% at age <30 years to 70.5% at age ≥50 years. The frequency of detection was higher among white (non-Hispanic) women, 69.4%, compared with nonwhite (Hispanic, Black, Asian) women, 42.3%. Breast cancer detection was higher (55.3%) among the lowest income group (<$40,345) than among higher income groups (45.6%) and higher among patients with Medicare (89.2%) and Medicaid (50%) compared with private, other, or no medical insurance (38.1%–44.4%). Detection was higher among women with a family history of breast cancer (55.0%) compared with no family history (46.7%) and higher among nulliparous women (100%) than nonnulliparous women (29.1%). These data suggest that aspects of socioeconomic status may be as predictive of sonographically detected breast cancer as age, ethnicity, and nulliparity.
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Koroukian SM, Bakaki PM, Golchin N, Tyler CV, Owusu C, Loue S. Breast Cancer Stage and Treatment Among Ohio Medicaid Beneficiaries With and Without Mental Illness. J Oncol Pract 2014; 11:e50-8. [PMID: 25466705 DOI: 10.1200/jop.2014.000034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE There is a dearth of studies on cancer outcomes in individuals with mental illness. We compared breast cancer outcomes in Medicaid beneficiaries with and without mental illness. METHODS Using records from the 1996 to 2005 Ohio Cancer Incidence Surveillance System (OCISS) and Medicaid files, we identified fee-for-service women age < 65 years diagnosed with incident invasive breast cancer who had enrolled in Medicaid ≥ 3 months before cancer diagnosis (n = 2,177). We retrieved cancer stage, patient demographics, and county of residence from the OCISS. From Medicaid claims data, we identified breast cancer treatment based on procedure codes and mental illness status based on diagnosis codes, prescription drugs dispensed, and service codes. We developed logistic regression models to examine the association between mental illness, cancer stage, and treatment for locoregional disease, adjusting for potential confounders. RESULTS Women with mental illness represented 60.2% of the study population. Adjusting for potential confounders, women with mental illness were less likely than those without mental illness to have unstaged or unknown-stage cancer (adjusted odds ratio [OR], 0.61; 95% CI, 0.44 to 0.86; P = .005) or to be diagnosed with distant-stage cancer (adjusted OR, 0.59; 95% CI, 0.40 to 0.85; P = .005). We observed no difference by mental illness status in receipt of definitive treatment (adjusted OR, 1.04; 95% CI, 0.84 to 1.29; P = .08). CONCLUSION Among Ohio Medicaid beneficiaries, women with mental illness did not experience disparities in breast cancer stage or treatment of locoregional disease. These findings may reflect the equalizing effects of Medicaid through vulnerable individuals' improved access to both physical and mental health care.
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Affiliation(s)
- Siran M Koroukian
- Case Western Reserve University School of Medicine; Case Comprehensive Cancer Center; Cleveland Clinic Foundation; and University Hospitals of Cleveland, Cleveland, OH
| | - Paul M Bakaki
- Case Western Reserve University School of Medicine; Case Comprehensive Cancer Center; Cleveland Clinic Foundation; and University Hospitals of Cleveland, Cleveland, OH
| | - Negar Golchin
- Case Western Reserve University School of Medicine; Case Comprehensive Cancer Center; Cleveland Clinic Foundation; and University Hospitals of Cleveland, Cleveland, OH
| | - Carl V Tyler
- Case Western Reserve University School of Medicine; Case Comprehensive Cancer Center; Cleveland Clinic Foundation; and University Hospitals of Cleveland, Cleveland, OH
| | - Cynthia Owusu
- Case Western Reserve University School of Medicine; Case Comprehensive Cancer Center; Cleveland Clinic Foundation; and University Hospitals of Cleveland, Cleveland, OH
| | - Sana Loue
- Case Western Reserve University School of Medicine; Case Comprehensive Cancer Center; Cleveland Clinic Foundation; and University Hospitals of Cleveland, Cleveland, OH
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Walker GV, Grant SR, Guadagnolo BA, Hoffman KE, Smith BD, Koshy M, Allen PK, Mahmood U. Disparities in stage at diagnosis, treatment, and survival in nonelderly adult patients with cancer according to insurance status. J Clin Oncol 2014; 32:3118-25. [PMID: 25092774 PMCID: PMC4876335 DOI: 10.1200/jco.2014.55.6258] [Citation(s) in RCA: 229] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE The purpose of this study was to determine the association of insurance status with disease stage at presentation, treatment, and survival among the top 10 most deadly cancers using the SEER database. PATIENTS AND METHODS A total of 473,722 patients age 18 to 64 years who were diagnosed with one of the 10 most deadly cancers in the SEER database from 2007 to 2010 were analyzed. A Cox proportional hazards model was used for multivariable analyses to assess the effect of patient and tumor characteristics on cause-specific death. RESULTS Overall, patients with non-Medicaid insurance were less likely to present with distant disease (16.9%) than those with Medicaid coverage (29.1%) or without insurance coverage (34.7%; P < .001). Patients with non-Medicaid insurance were more likely to receive cancer-directed surgery and/or radiation therapy (79.6%) compared with those with Medicaid coverage (67.9%) or without insurance coverage (62.1%; P < .001). In a Cox regression that adjusted for age, race, sex, marital status, residence, percent of county below federal poverty level, site, stage, and receipt of cancer-directed surgery and/or radiation therapy, patients were more likely to die as a result of their disease if they had Medicaid coverage (hazard ratio [HR], 1.44; 95% CI, 1.41 to 1.47; P < .001) or no insurance (HR, 1.47; 95% CI, 1.42 to 1.51; P < .001) compared with non-Medicaid insurance. CONCLUSION Among patients with the 10 most deadly cancers, those with Medicaid coverage or without insurance were more likely to present with advanced disease, were less likely to receive cancer-directed surgery and/or radiation therapy, and experienced worse survival.
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Affiliation(s)
- Gary V Walker
- Gary V. Walker, B. Ashleigh Guadagnolo, Karen E. Hoffman, Benjamin D. Smith, Pamela K. Allen, and Usama Mahmood, University of Texas MD Anderson Cancer Center; Gary V. Walker, University of Texas Health Science Center School of Biomedical Informatics; Stephen R. Grant, Baylor College of Medicine, Houston, TX; and Matthew Koshy, University of Chicago, Chicago, IL
| | - Stephen R Grant
- Gary V. Walker, B. Ashleigh Guadagnolo, Karen E. Hoffman, Benjamin D. Smith, Pamela K. Allen, and Usama Mahmood, University of Texas MD Anderson Cancer Center; Gary V. Walker, University of Texas Health Science Center School of Biomedical Informatics; Stephen R. Grant, Baylor College of Medicine, Houston, TX; and Matthew Koshy, University of Chicago, Chicago, IL
| | - B Ashleigh Guadagnolo
- Gary V. Walker, B. Ashleigh Guadagnolo, Karen E. Hoffman, Benjamin D. Smith, Pamela K. Allen, and Usama Mahmood, University of Texas MD Anderson Cancer Center; Gary V. Walker, University of Texas Health Science Center School of Biomedical Informatics; Stephen R. Grant, Baylor College of Medicine, Houston, TX; and Matthew Koshy, University of Chicago, Chicago, IL
| | - Karen E Hoffman
- Gary V. Walker, B. Ashleigh Guadagnolo, Karen E. Hoffman, Benjamin D. Smith, Pamela K. Allen, and Usama Mahmood, University of Texas MD Anderson Cancer Center; Gary V. Walker, University of Texas Health Science Center School of Biomedical Informatics; Stephen R. Grant, Baylor College of Medicine, Houston, TX; and Matthew Koshy, University of Chicago, Chicago, IL
| | - Benjamin D Smith
- Gary V. Walker, B. Ashleigh Guadagnolo, Karen E. Hoffman, Benjamin D. Smith, Pamela K. Allen, and Usama Mahmood, University of Texas MD Anderson Cancer Center; Gary V. Walker, University of Texas Health Science Center School of Biomedical Informatics; Stephen R. Grant, Baylor College of Medicine, Houston, TX; and Matthew Koshy, University of Chicago, Chicago, IL
| | - Matthew Koshy
- Gary V. Walker, B. Ashleigh Guadagnolo, Karen E. Hoffman, Benjamin D. Smith, Pamela K. Allen, and Usama Mahmood, University of Texas MD Anderson Cancer Center; Gary V. Walker, University of Texas Health Science Center School of Biomedical Informatics; Stephen R. Grant, Baylor College of Medicine, Houston, TX; and Matthew Koshy, University of Chicago, Chicago, IL
| | - Pamela K Allen
- Gary V. Walker, B. Ashleigh Guadagnolo, Karen E. Hoffman, Benjamin D. Smith, Pamela K. Allen, and Usama Mahmood, University of Texas MD Anderson Cancer Center; Gary V. Walker, University of Texas Health Science Center School of Biomedical Informatics; Stephen R. Grant, Baylor College of Medicine, Houston, TX; and Matthew Koshy, University of Chicago, Chicago, IL
| | - Usama Mahmood
- Gary V. Walker, B. Ashleigh Guadagnolo, Karen E. Hoffman, Benjamin D. Smith, Pamela K. Allen, and Usama Mahmood, University of Texas MD Anderson Cancer Center; Gary V. Walker, University of Texas Health Science Center School of Biomedical Informatics; Stephen R. Grant, Baylor College of Medicine, Houston, TX; and Matthew Koshy, University of Chicago, Chicago, IL.
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Fitzgerald TL, Lea CS, Atluri PM, Brinkley J, Zervos EE. Insurance Payer Status and Race Explains Much of the Variability in Colorectal Cancer Survival. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/jct.2014.513124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Farkas DT, Greenbaum A, Singhal V, Cosgrove JM. Effect of insurance status on the stage of breast and colorectal cancers in a safety-net hospital. J Oncol Pract 2012; 8:16s-21s. [PMID: 22942818 DOI: 10.1200/jop.2012.000542] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2012] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Screening can increase early detection and reduce rates of advanced-stage cancer. Uninsured patients have been shown to have lower rates of screening. Previous studies have shown that uninsured patients and patients with Medicaid present with more advanced stages of cancer. The aim of this study was to measure the effect of insurance status in the setting of a safety-net hospital. METHODS Patients in our tumor registry with a diagnosis of breast or colorectal cancer between 2001 and 2010 were included. On the basis of their insurance status, they were divided into the following groups: Medicaid, Medicare, Medicare age < 65 years, commercial, uninsured, and unknown. Cancer stage was recorded for each patient, with stages III and IV considered advanced disease. The primary end point was the rate of advanced disease in each patient group. RESULTS A total of 910 patients were included in the study: 836 (91.9%) insured, 54 (5.9%) uninsured, and 20 (2.2%) unknown. Of the insured patients, 301 (36.0%) had Medicaid. Two hundred thirty-seven (30.7%) of 836 insured patients had advanced disease, compared with 27 (50.0%) of 54 uninsured patients (odds ratio, 1.63; P = .003). Of patients with Medicaid, 83 (27.6%) of 301 had advanced disease, which was not statistically different from patients with other insurance. CONCLUSION In a safety-net hospital, patients with Medicaid had rates of advanced-stage cancer similar to those in patients with other types of insurance. However, patients with no insurance had significantly higher rates of advanced disease. This has significant ramifications in view of the new health care law, which will convert many patients from being uninsured to having Medicaid.
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Affiliation(s)
- Daniel T Farkas
- Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, NY
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Fedewa SA, Cokkinides V, Virgo KS, Bandi P, Saslow D, Ward EM. Association of insurance status and age with cervical cancer stage at diagnosis: National Cancer Database, 2000-2007. Am J Public Health 2012; 102:1782-90. [PMID: 22742058 DOI: 10.2105/ajph.2011.300532] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the relationship of age at diagnosis and insurance status with stage among cervical cancer patients aged 21 to 85 years. METHODS We selected data on women (n = 69 739) diagnosed with invasive cervical cancer between 2000 and 2007 from the National Cancer Database. We evaluated the association between late stage (stage III/IV) and both insurance and age, with adjustment for race/ethnicity and other sociodemographic and clinical factors. We used multivariable log binomial models to estimate risk ratios (RRs) and 95% confidence intervals (CIs). RESULTS The proportion of late-stage disease increased with age: from 16.53% (21-34 years) to 42.44% (≥ 70 years). The adjusted relative risk of advanced-stage disease among women aged 50 years and older was 2.2 to 2.5 times that of patients aged 21 to 34 years. Uninsured (RR = 1.44; 95% CI = 1.40, 1.49), Medicaid (RR = 1.37, 95% CI = 1.34, 1.41), younger Medicare (RR = 1.12, 95% CI = 1.06, 1.19), and older Medicare (RR = 1.20, 95% CI = 1.15, 1.26) patients had a higher risk of late-stage disease than did privately insured patients. CONCLUSIONS Screening should be encouraged for women at high risk for advanced-stage disease.
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Affiliation(s)
- Stacey A Fedewa
- Department of Research, American Cancer Society, Atlanta, GA 30303, USA.
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Cancer diagnosis and outcomes in Michigan EDs vs other settings. Am J Emerg Med 2012; 30:283-92. [DOI: 10.1016/j.ajem.2010.11.029] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Revised: 11/17/2010] [Accepted: 11/20/2010] [Indexed: 11/23/2022] Open
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Chien LN, Adams EK, Yang Z. Medicaid enrollment at early stage of disease: the Breast and Cervical Cancer Prevention and Treatment Act in Georgia. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2012; 48:197-208. [PMID: 22235545 DOI: 10.5034/inquiryjrnl_48.03.02] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This study linked data from the Georgia Comprehensive Cancer Registry to Medicaid enrollment and claims to test whether the Breast and Cervical Cancer Prevention and Treatment Act (BCCPTA), which provided a new and quicker pathway to Medicaid eligibility for low-income breast cancer patients, led to more patients enrolling at an early stage of disease. Results based on difference-in-differences analysis indicated that Georgia's BCCPTA increased by 11 percentage points the probability of breast cancer patients enrolling in Medicaid at an early stage (p = .024). This effect could mean more treatment options and higher survival rates for these patients.
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Cancer stage comparison between dual Medicare-Medicaid eligibles using Medicaid as a supplemental health insurance program and low-income nonduals. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2012; 17:479-91. [PMID: 21964357 DOI: 10.1097/phh.0b013e31821a3f8c] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Dual-eligibility status for both Medicare and Medicaid is associated with unfavorable cancer stage outcomes. However, given the reduced financial barriers, duals enrolled in Medicaid prior to cancer diagnosis-or those using Medicaid as a supplemental health insurance program (Dual/SHIP)-may have improved access to preventive services compared with low-income nonduals (LI/nondual), therefore, be more likely to be diagnosed at earlier stages of cancers amenable to screening. OBJECTIVES To compare breast, prostate, and colorectal cancer stage at diagnosis between Duals/SHIP and LI/nonduals, adjusting for sociodemographic variables, comorbidities, and nursing home status. RESEARCH DESIGN Cross-sectional study using a database developed by linking records from the Ohio Cancer Incidence Surveillance System with Medicare and Medicaid files, as well as US census data. SUBJECTS Fee-for-service, Ohio residents aged 65 years or older, and diagnosed with incident breast, prostate, or colorectal cancer in 1997-2001. MEASURES (1) Unknown stage/unstaged cancer and (2) distant-stage cancer at diagnosis. RESULTS Duals/SHIP were more likely than LI/nonduals to have unknown stage/unstaged breast cancer (adjusted odds ratio: 1.43, 95% Confidence Interval (CI): 1.02-2.0; P = .035). However, this difference was not seen in prostate or colorectal cancer. In prostate cancer patients, but not in breast or colorectal cancer patients, Dual/SHIP status was associated with distant-stage disease (adjusted odds ratio: 1.74, 95% CI: 1.12-2.70; P = .014). In colorectal cancer patients, dual status was not associated with cancer stage. CONCLUSION The findings show no benefit associated with Medicaid as SHIP. Rather, they indicate that for the most part, cancer stage is comparable between Duals/SHIP and LI/nonduals.
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Schapmire TJ, Head BA, Faul AC. Just give me hope: lived experiences of Medicaid patients with advanced cancer. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2012; 8:29-52. [PMID: 22424383 DOI: 10.1080/15524256.2012.650672] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The purpose of this phenomenological exploration was to describe the lived experiences of persons diagnosed with advanced cancer who receive Medicaid. Themes emerged from the transcribed interviews of 10 participants in accordance with the cancer trajectory. Before diagnosis, participants were uninsured or underinsured and had more severe symptoms prior to late diagnosis. Upon diagnosis, they desired hopeful, respectful communication and experienced strong emotional reactions. There was also an abrupt change in the use of health care resources. During cancer treatment, they experienced social isolation from family and friends while receiving strong psychosocial support from the health care team. Throughout the cancer trajectory, they focused on living, reclaiming normalcy, and expressed resiliency and spirituality. Findings support the need to recognize the "fighting spirit" of patients regardless of prognosis or socioeconomic status; the impact of hopeful, respectful communication; and the value of oncology social work assistance when navigating the cancer experience. Lack of health care coverage prior to severe symptoms prevented earlier diagnosis and contributed to poor physical outcomes. Medicaid eligibility enabled these patients to receive quality health care and focus on living beyond cancer.
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Affiliation(s)
- Tara J Schapmire
- School of Medicine, University of Louisville, Louisville, Kentucky 40202, USA.
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