1
|
Fiala MA, Ji M, Shih YH, Huber J, Wang M, Johnson KJ, Gasoyan H, Wang R, Colditz GA, Wang SY, Chang SH. Treatment Access among Younger Medicaid Beneficiaries with Multiple Myeloma. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024:S2152-2650(24)00286-6. [PMID: 39209567 DOI: 10.1016/j.clml.2024.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 07/15/2024] [Accepted: 07/26/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE Continuous Medicaid coverage prior to a cancer diagnosis has been associated with earlier detection and better outcomes, for patients with solid tumors. In this study, we aimed to determine if this was observed among patients with multiple myeloma, a hematologic cancer where there are no routine screening tests and most are diagnosed through acute medical events. MATERIALS AND METHODS This is an analysis of the Merative MarketScan Multistate Medicaid Database, a claims-based dataset. In total, 1105 patients < 65 years old were included in the analyses. Among them, 66% had continuous enrollment (at least 6 months enrollment prior to myeloma), and 34% had discontinuous enrollment (2-6 months enrollment prior to myeloma). Multivariable Cox regression was used to estimate the association between continuous enrollment status and receipt of myeloma treatment within 1 year of index date. RESULTS Only 54% of all Medicaid enrollees received myeloma therapy and only 12% received stem cell transplant within the 1st year. Those with continuous enrollment were less likely to receive any treatment (adjusted hazard ratio [aHR] 0.59; 95% confidence interval [CI] 0.59-0.70; P < .001) and to receive stem cell transplant (aHR 0.51; 95% CI 0.32-0.81; P = .005). CONCLUSION Patients with continuous Medicaid coverage prior to diagnosis were less likely to receive myeloma therapy. Future studies should examine whether myeloma patients with continuous Medicaid enrollment have more chronic financial instability and/or higher medical needs and, thus, have higher barriers to care.
Collapse
Affiliation(s)
- Mark A Fiala
- Division of Oncology, Washington University School of Medicine, St Louis MO.
| | - Mengmeng Ji
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St Louis MO
| | - Yi-Hsuan Shih
- Department of Electrical & Systems Engineering, Washington University School of Medicine, St Louis MO
| | - John Huber
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St Louis MO
| | - Mei Wang
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St Louis MO
| | - Kimberly J Johnson
- Brown School of Social Work, Washington University School of Medicine, St Louis MO
| | - Hamlet Gasoyan
- Department of Internal Medicine and Geriatrics, Center for Value-Based Care Research, Primary Care Institute, Cleveland Clinic, Cleveland OH
| | - Rong Wang
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven CT
| | - Graham A Colditz
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St Louis MO
| | - Shi-Yi Wang
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven CT
| | - Su-Hsin Chang
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St Louis MO
| |
Collapse
|
2
|
Bradley CJ, Sabik LM, Liang R, Lindrooth RC, Perraillon MC. Treatment Disparities in Radiation and Hormone Therapy Among Women Covered by Medicaid vs Private Insurance in Cancer Registry and Claims Data. JAMA HEALTH FORUM 2023; 4:e230673. [PMID: 37145688 PMCID: PMC10163382 DOI: 10.1001/jamahealthforum.2023.0673] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
Importance Prior research has reported undertreatment among patients with cancer who are insured by Medicaid, but this finding may be due, in part, to incomplete data in cancer registries. Objective To compare disparities in radiation and hormone therapy between women with breast cancer covered by Medicaid and those with private insurance using the Colorado Central Cancer Registry (CCCR) and CCCR data supplemented with All Payer Claims Data (APCD). Design, Setting, and Participants This observational cohort study included women aged 21 to 63 years who received breast cancer surgery. We linked the CCCR and Colorado APCD to identify Medicaid and privately insured women who were newly diagnosed with invasive, nonmetastatic breast cancer between January 1, 2012, and December 31, 2017. In the radiation treatment analysis, we narrowed the sample to women who received breast-conserving surgery (Medicaid, n = 1408; private, n = 1984) and in the hormone therapy analysis, we selected women who were hormone-receptor positive (Medicaid, n = 1156; private, n = 1667). Main Outcomes and Measures We used logistic regression to estimate the likelihood of treatment within 12 months to assess whether the results varied between data sources. Results There were 3392 and 2823 participants in the radiation and hormone therapy cohorts, respectively. The mean (SD) age was 51.71 (8.30) years in the radiation therapy cohort, and 52.00 (8.16) years in the hormone therapy cohort. Among the participants, there were 140 (4%) and 105 (4%) who were Black non-Hispanic, 499 (15%) and 406 (14%) who were Hispanic, 2602 (77%) and 2190 (78%) were White, and 151 (4%) and 122 (4%) were other/unknown in the radiation and hormone therapy cohorts, respectively. A higher percentage of women were aged 50 years or younger in the Medicaid samples (40% vs 34% in the privately insured sample) and identified as non-Hispanic Black (about 7%) or Hispanic (approximately 24%). Treatment was underreported in both sources, but to a lesser extent in the APCD (2.5% and 2.0% for Medicaid and private insurance, respectively) compared with CCCR (19.5% and 13.3% for Medicaid and private insurance, respectively). Using CCCR data, Women with Medicaid insurance were 4 (95% CI, -8 to -1; P = .02) and 10 (95% CI, -14 to -6; P < .001) percentage points less likely to have a record of radiation and hormone therapy compared with privately insured women, respectively. Using combined CCCR and APCD, no statistically significant disparity was observed in radiation or hormone therapy between Medicaid-insured and privately insured women. Conclusions and Relevance Among women with breast cancer covered by Medicaid vs private insurance, cancer treatment disparities may be overestimated if based solely on cancer registry data.
Collapse
Affiliation(s)
- Cathy J Bradley
- University of Colorado Cancer Center, Aurora
- Colorado School of Public Health, Aurora
| | - Lindsay M Sabik
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Rifei Liang
- University of Colorado Cancer Center, Aurora
| | | | - Marcelo C Perraillon
- University of Colorado Cancer Center, Aurora
- Colorado School of Public Health, Aurora
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Unger JM, Blanke CD, LeBlanc M, Barlow WE, Vaidya R, Ramsey SD, Hershman DL. Association of Patient Demographic Characteristics and Insurance Status With Survival in Cancer Randomized Clinical Trials With Positive Findings. JAMA Netw Open 2020; 3:e203842. [PMID: 32352530 PMCID: PMC7193331 DOI: 10.1001/jamanetworkopen.2020.3842] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE Few new treatments tested in phase 3 cancer randomized clinical trials show an overall survival benefit. Although understanding whether the benefits are consistent among all patient groups is critical for informing guideline care, individual trials are designed to assess the benefits of experimental treatments among all patients and are too small to reliably determine whether treatment benefits apply to demographic or insurance subgroups. OBJECTIVE To systematically examine whether positive treatment effects in cancer randomized clinical trials apply to specific demographic or insurance subgroups. DESIGN, SETTING, AND PARTICIPANTS Cohort study of pooled patient-level data from 10 804 patients in SWOG Cancer Research Network clinical treatment trials reported from 1985 onward with superior overall survival for those receiving experimental treatment. Patients were enrolled from 1984 to 2012. Maximum follow-up was 5 years. MAIN OUTCOMES AND MEASURES Interaction tests were used to assess whether hazard ratios (HRs) for death comparing standard group vs experimental group treatments were associated with age (≥65 vs <65 years), race/ethnicity (minority vs nonminority populations), sex, or insurance status among patients younger than 65 years (Medicaid or no insurance vs private insurance) in multivariable Cox regression frailty models. Progression- or relapse-free survival was also examined. Data analyses were conducted from August 2019 to February 2020. RESULTS In total, 19 trials including 10 804 patients were identified that reported superior overall survival for patients randomized to experimental treatment. Patients were predominantly younger than 65 years (67.3%) and female (66.3%); 11.4% were black patients, and 5.7% were Hispanic patients. There was evidence of added survival benefits associated with receipt of experimental therapy for all groups except for patients with Medicaid or no insurance (HR, 1.23; 95% CI, 0.97-1.56; P = .09) compared with those with private insurance (HR, 1.66; 95% CI, 1.44-1.92; P < .001; P = .03 for interaction). Receipt of experimental treatment was associated with reduced added overall survival benefits in patients 65 years or older (HR, 1.21; 95% CI, 1.11-1.32; P < .001) compared with patients younger than 65 years (HR, 1.41; 95% CI, 1.30-1.53; P < .001; P = .01 for interaction), although both older and younger patients appeared to strongly benefit from receipt of experimental treatment. The progression- or relapse-free survival HRs did not differ by age, sex, or race/ethnicity but differed between patients with Medicaid or no insurance (HR, 1.32; 95% CI, 1.06-1.64; P = .01) vs private insurance (HR, 1.74; 95% CI, 1.54-1.97; P < .001; P = .03 for interaction). CONCLUSIONS AND RELEVANCE Patients with Medicaid or no insurance may have smaller added benefits from experimental therapies compared with standard treatments in clinical trials. A better understanding of the quality of survivorship care that patients with suboptimal insurance receive, including supportive care and posttreatment care, could help establish how external factors may affect outcomes for these patients.
Collapse
Affiliation(s)
- Joseph M. Unger
- SWOG Cancer Research Network Statistics and Data Management Center, Seattle, Washington
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Charles D. Blanke
- SWOG Cancer Research Network Group Chair’s Office, Knight Cancer Institute, Oregon Health & Science University, Portland
| | - Michael LeBlanc
- SWOG Cancer Research Network Statistics and Data Management Center, Seattle, Washington
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - William E. Barlow
- SWOG Cancer Research Network Statistics and Data Management Center, Seattle, Washington
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Riha Vaidya
- SWOG Cancer Research Network Statistics and Data Management Center, Seattle, Washington
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | |
Collapse
|
5
|
Tsui J, DeLia D, Stroup AM, Nova J, Kulkarni A, Ferrante JM, Cantor JC. Association of Medicaid enrollee characteristics and primary care utilization with cancer outcomes for the period spanning Medicaid expansion in New Jersey. Cancer 2018; 125:1330-1340. [DOI: 10.1002/cncr.31824] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/30/2018] [Accepted: 09/28/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Jennifer Tsui
- Cancer Institute of New Jersey Rutgers, the State University of New Jersey New Brunswick New Jersey
- School of Public Health Rutgers, the State University of New Jersey Piscataway New Jersey
| | - Derek DeLia
- MedStar Health Research Institute Hyattsville Maryland
| | - Antoinette M. Stroup
- Cancer Institute of New Jersey Rutgers, the State University of New Jersey New Brunswick New Jersey
- School of Public Health Rutgers, the State University of New Jersey Piscataway New Jersey
- New Jersey State Cancer Registry New Jersey Department of Health Trenton New Jersey
| | - Jose Nova
- Center for State Health Policy Rutgers, the State University of New Jersey New Brunswick New Jersey
| | - Aishwarya Kulkarni
- Cancer Institute of New Jersey Rutgers, the State University of New Jersey New Brunswick New Jersey
- New Jersey State Cancer Registry New Jersey Department of Health Trenton New Jersey
| | - Jeanne M. Ferrante
- Department of Family Medicine, Robert Wood Johnson Medical School Rutgers, the State University of New Jersey New Brunswick New Jersey
| | - Joel C. Cantor
- Center for State Health Policy Rutgers, the State University of New Jersey New Brunswick New Jersey
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Koroukian SM, Bakaki PM, Han X, Schluchter M, Owusu C, Cooper GS, Flocke SA. Lasting Effects of the Breast and Cervical Cancer Early Detection Program on Breast Cancer Detection and Outcomes, Ohio, 2000-2009. Prev Chronic Dis 2015. [PMID: 26203814 PMCID: PMC4515916 DOI: 10.5888/pcd12.140491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction The National Breast and Cervical Cancer Early Detection Program (BCCP) in Ohio provides screening and treatment services for uninsured low-income women aged 40 to 64. Because participation in the BCCP might engender greater self-efficacy for cancer screening, we hypothesized that breast cancer and survival outcomes would be better in BCCP participants who become age-eligible to transition to Medicare than in their low-income non-BCCP counterparts. Methods Linking data from the 2000 through 2009 Ohio Cancer Incidence Surveillance System with the BCCP database, Medicare files, Ohio death certificates (through 2010), and the US Census, we identified Medicare beneficiaries who were aged 66 to 74 and diagnosed with incident invasive breast cancer. We compared the following outcomes between BCCP women (n = 93) and low-income non-BCCP women (n = 420): receipt of screening mammography in previous year, advanced-stage disease at diagnosis, timely and standard care, all-cause survival, and cancer survival. We conducted multivariable logistic regression and survival analysis to examine the association between BCCP status and each of the outcomes, adjusting for patient covariates. Results Women who participated in the BCCP were nearly twice as likely as low-income non-BCCP women to have undergone screening mammography in the previous year (adjusted odds ratio, 1.77; 95% confidence interval, 1.01–3.09). No significant differences were detected in any other outcomes. Conclusion With the exception of screening mammography, the differences in outcomes were not significant, possibly because of the small size of the study population. Future analysis should be directed toward identifying the factors that explain these findings.
Collapse
Affiliation(s)
- Siran M Koroukian
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, 10900 Euclid Ave, WG-49, Cleveland, OH 44106-4945. . Dr Koroukian is also affiliated with Case Comprehensive Cancer Center and Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Case Western Reserve University, Cleveland, Ohio
| | - Paul M Bakaki
- School of Medicine, and Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Case Western Reserve University, Cleveland, Ohio
| | - Xiaozhen Han
- School of Medicine, and Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Case Western Reserve University, Cleveland, Ohio
| | - Mark Schluchter
- School of Medicine and Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Cynthia Owusu
- Case Comprehensive Cancer Center and University Hospitals of Cleveland, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Gregory S Cooper
- Case Comprehensive Cancer Center and University Hospitals of Cleveland, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Susan A Flocke
- School of Medicine and Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| |
Collapse
|
8
|
Dawes AJ, Louie R, Nguyen DK, Maggard-Gibbons M, Parikh P, Ettner SL, Ko CY, Zingmond DS. The impact of continuous Medicaid enrollment on diagnosis, treatment, and survival in six surgical cancers. Health Serv Res 2014; 49:1787-811. [PMID: 25256223 PMCID: PMC4254125 DOI: 10.1111/1475-6773.12237] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To examine the effect of Medicaid enrollment on the diagnosis, treatment, and survival of six surgically relevant cancers among poor and underserved Californians. DATA SOURCES California Cancer Registry (CCR), California's Patient Discharge Database (PDD), and state Medicaid enrollment files between 2002 and 2008. STUDY DESIGN We linked clinical and administrative records to differentiate patients continuously enrolled in Medicaid from those receiving coverage at the time of their cancer diagnosis. We developed multivariate logistic regression models to predict death within 1 year for each cancer after controlling for sociodemographic and clinical variables. DATA COLLECTION/EXTRACTION METHODS All incident cases of six cancers (colon, esophageal, lung, pancreas, stomach, and ovarian) were identified from CCR. CCR records were linked to hospitalizations (PDD) and monthly Medicaid enrollment. PRINCIPAL FINDINGS Continuous enrollment in Medicaid for at least 6 months prior to diagnosis improves survival in three surgically relevant cancers. Discontinuous Medicaid patients have higher stage tumors, undergo fewer definitive operations, and are more likely to die even after risk adjustment. CONCLUSIONS Expansion of continuous insurance coverage under the Affordable Care Act is likely to improve both access and clinical outcomes for cancer patients in California.
Collapse
Affiliation(s)
- Aaron J Dawes
- Department of Surgery, David Geffen School of Medicine at the University of CaliforniaLos Angeles, 757 Westwood Plaza, B711, Los Angeles, CA 90095
- Robert Wood Johnson Clinical Scholars Program, University of CaliforniaLos Angeles, CAVA Greater Los Angeles Healthcare SystemLos Angeles, CA
| | - Rachel Louie
- Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of CaliforniaLos Angeles, CA
| | - David K Nguyen
- Department of Surgery, David Geffen School of Medicine at the University of CaliforniaLos Angeles, CA
| | - Melinda Maggard-Gibbons
- Department of Surgery, David Geffen School of Medicine at the University of CaliforniaLos AngelesVA Greater Los Angeles Healthcare SystemLos Angeles, CA
| | - Punam Parikh
- Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of CaliforniaLos Angeles, CA
- Department of Surgery, David Geffen School of Medicine at the University of CaliforniaLos Angeles, CA
| | - Susan L Ettner
- Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of CaliforniaLos Angeles, CA
- Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health at the University of CaliforniaLos Angeles, CA
| | - Clifford Y Ko
- Department of Surgery, David Geffen School of Medicine at the University of CaliforniaLos AngelesVA Greater Los Angeles Healthcare SystemLos Angeles, CA
| | - David S Zingmond
- Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of CaliforniaLos Angeles, CA
- Department of Surgery, David Geffen School of Medicine at the University of CaliforniaLos Angeles, CA
| |
Collapse
|
9
|
Johnston EM, Blake SC, Andes KL, Chien LN, Adams EK. Breast cancer treatment experiences by race and location in Georgia's Women's Health Medicaid Program. Womens Health Issues 2014; 24:e219-29. [PMID: 24560120 DOI: 10.1016/j.whi.2014.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 12/10/2013] [Accepted: 01/10/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND This study seeks to understand the breast cancer treatment patterns and experiences of women enrolled in Georgia's Breast and Cervical Cancer Prevention and Treatment Act program, the Women's Health Medicaid Program (WHMP), and whether these experiences vary by race or location. METHODS We conducted a mixed-methods analysis of WHMP breast cancer enrollees by race and urban/rural location. Quantitative analysis used a hazard rate model approach to identify differences in the timing of diagnosis, enrollment into Medicaid, and various modalities of treatment for 810 enrollees. Qualitative analysis used a systematic retrieval and review of coded data from 34 in-depth disease life history interview transcripts to a complete, focused analysis of enrollees' cancer treatment experiences. FINDINGS African-American women began treatment, on average, 6 days later after diagnosis than White women, driven by delays of one month among African-American women with late-stage cancers. This time delay for African-American women was not significant on multivariate analysis of time from enrollment to treatment. Once enrolled in WHMP, women reported gaining access to equitable breast cancer treatment regardless of race or location, with the exception of breast reconstruction, for which some women in our sample reported barriers to care. CONCLUSIONS The equitable access to cancer treatment and other health services provided by WHMP to low-income, uninsured women in Georgia with breast cancer makes it a critical health care safety net program in Georgia, the need for which will continue through the implementation of the Affordable Care Act.
Collapse
Affiliation(s)
- Emily M Johnston
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia.
| | - Sarah C Blake
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Karen L Andes
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Li-Nien Chien
- School of Health Care Administration, College of Public Health and Nutrition, Taipei Medical University, Taipei City, Taiwan
| | - E Kathleen Adams
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| |
Collapse
|