The implications of insurance status on presentation, surgical management, and mortality among nonmetastatic breast cancer patients in Indiana

Obeng‐Gyasi, Samilia; Timsina, Lava; Miller, Kathy D.; Ludwig, Kandice K.; Fisher, Carla S.; Haggstrom, David A.

doi:10.1016/j.surg.2018.07.012

Cited by 16 publications

(13 citation statements)

References 27 publications

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“…19 Regarding survival rates according to healthcare coverage, previous studies have reported an association between worse outcomes and public medical insurance. 11,15,23,27,28,35,36 However, in our study, patients with public healthcare coverage did not have worse recurrence-free and overall survival than patients with private healthcare coverage. It could be argued that the absence of differences in survival between patients with private and public healthcare coverage may have been influenced by the fact that patients with Seguro Popular had access to the main treatment modalities as patients with private healthcare coverage at TecSalud; therefore, all patients were treated in a similar fashion, by the same group of healthcare professionals with equal infrastructure, regardless of medical coverage.…”

Section: Discussioncontrasting

confidence: 64%

“…Furthermore, patients with public medical coverage had more advanced disease at diagnosis than those with private healthcare coverage, as described in other previous studies. 11 , 12 , 15 , 16 , 23 , 25 – 29 This could be explained by the high percentage of BC diagnoses made by self-detection (82.8% vs 47.9%, p < 0.001), rather than by screening mammography in patients with public healthcare coverage. A previous Mexican study identified that advanced BC stages at diagnosis are associated with diagnosis delay, which in turn is influenced by patients’ lack of BC awareness (dismissing symptoms as “not worrisome”), limited social network (the longer a patient conceals her symptoms from others, the longer she delays medical care), financial difficulties in seeking care (unable to justify taking medical leave from their jobs), as well as perception of medical errors in diagnostic impressions of the first doctors consulted.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of characteristics in Mexican women with breast cancer according to healthcare coverage

Martínez-Cannon

Zertuche-Maldonado

Pacheco

et al. 2020

Womens Health (Lond Engl)

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Objective: To compare the sociodemographic, diagnostic, clinical, and treatment-related characteristics and outcomes of patients with breast cancer in two hospitals in Mexico according to type of healthcare coverage. Methods: A retrospective cohort study of women with breast cancer according to public or private healthcare coverage in two hospitals was done. Patients were treated by the same group of physicians and healthcare infrastructure. Groups were compared using the chi-square test for categorical variables, Mann–Whitney U-test and Student’s t-test for quantitative variables, and Kaplan–Meier estimator and log-rank test for time dependent outcomes (including recurrence-free and overall survival). A value of p < 0.05 was considered statistically significant. Results: A total of 282 women were included. Mean age at diagnosis was 52 years. Women with public healthcare coverage were diagnosed more frequently with self-detected tumors (82.8% vs 47.9%, p < 0.001) and advanced clinical stage (III and IV) (31.1% vs 17.8%, p = 0.014). More women with public healthcare insurance underwent initial systemic treatment (41.1% vs 17.8%, p < 0.001) and mastectomy (70.1% vs 54.9%, p = 0.020), and received more chemotherapy (79.4% vs 43.8%, p < 0.001) and adjuvant radiotherapy (68.9% vs 53.4%, p = 0.017). Overall, no differences were found in survival outcomes according to healthcare coverage. Trends suggesting worse recurrence-free and overall survival were observed in patients with public coverage at 3 years follow-up in stage III (85.7% vs 67.3% and 100% vs 84.6%, respectively) and triple negative disease (83.3% vs 74.5% and 100% vs 74.1%, respectively). Conclusion: Strategies to promote preventive medicine, diagnostic mammograms, and prompt diagnosis of breast cancer in Mexican women with public health coverage are needed. Access to the main treatment modalities by Seguro Popular and good quality care by an experienced group of physicians likely explains the similar outcomes between patients with private and public healthcare coverage. However, trends suggesting worse survival for patients with public medical coverage with stage III and triple-negative disease should encourage close follow-up.

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Section: Discussioncontrasting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Comparison of characteristics in Mexican women with breast cancer according to healthcare coverage

Martínez-Cannon

Zertuche-Maldonado

Pacheco

et al. 2020

Womens Health (Lond Engl)

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“…These previous studies have predominantly examined TTS from Medicare regional cancer registry populations, limiting their generalizability to commercially insured individuals. Significant differences in sociodemographic and clinical variables and outcomes, based on the type of insurance at presentation were identified by Obeng-Gyasi et al [14].…”

Section: Introductionmentioning

confidence: 94%

Variations in breast cancer surgical treatment and timing: determinants and disparities

Dankwa‐Mullan

George

Roebuck³

et al. 2021

Breast Cancer Res Treat

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Purpose To describe clinical and non-clinical factors associated with receipt of breast conserving surgery (BCS) versus mastectomy and time to surgical intervention. Methods Cross-sectional retrospective study of January 1, 2012 through March 31, 2018 data from the IBM MarketScan Commercial Claims and Encounter and Medicare Supplemental Databases. Area Health Resource Files provided non-clinical characteristics and sociodemographic data. Eligibility: Female sex, claim(s) with ICD-9-CM or ICD-10-CM diagnosis of non-metastatic invasive breast cancer, > 6 months of continuous insurance pre- and post-diagnosis, evidence of BCS or mastectomy following initial ICD9/10 code diagnosis. Logistic and quantile multivariable regression models assessed the association between clinical and non-clinical factors and the outcome of BCS and time to surgery, respectively. Results A total of 53,060 women were included in the study. Compared to mastectomy, BCS was significantly associated with older age (ORs: 1.54 to 2.99, 95% CIs 1.45 to 3.38; ps < .0001) and higher community density of medical genetics (OR: 5.88, 95% CIs 1.38 to 25.00; p = 0.02) or obstetrics and gynecology (OR: 1.13, 95% CI 1.02 to 1.25; p = .02) physicians. Shorter time-to-BCS was associated with living in the South (−2.96, 95% CI −4.39 to −1.33; p < .0001). Longer time-to-BCS was associated with residence in more urban (4.18, 95% CI 0.08 to 8.29; p = 0. 05), educated (9.02, 95% CI 0.13 to 17.91; p = 0.05), or plastic-surgeon-dense (4.62, 95% CI 0.50 to 8.73; p = 0.03) communities. Conclusions Clinical and non-clinical factors are associated with adoption of BCS and time to treatment, suggesting opportunities to ensure equitable and timely care.

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“…Specifically, the uninsured, Medicaid-insured, those with low socioeconomic status (SES), and Black women continue to present with advanced stages of breast cancer and consequently have higher mortality rates than their privately insured, high-SES, and White female counterparts. 3,4 Possible drivers of these disparities include, but are not limited to, differences in access to and receipt of high-quality surgical care.…”

Section: Pastmentioning

confidence: 99%

ASO Author Reflections: Disparities in Oncologic Surgery: The Problem We All Live with

Obeng‐Gyasi

Stover

2021

Ann Surg Oncol

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The implications of insurance status on presentation, surgical management, and mortality among nonmetastatic breast cancer patients in Indiana

Abstract: To improve insurance-based disparities in Indiana, implementation of the Breast and Cervical Cancer Program in conjunction with expansion of insurance coverage to vulnerable low-income populations need to be optimized.

Cited by 16 publications

References 27 publications

Comparison of characteristics in Mexican women with breast cancer according to healthcare coverage

Comparison of characteristics in Mexican women with breast cancer according to healthcare coverage

Variations in breast cancer surgical treatment and timing: determinants and disparities

ASO Author Reflections: Disparities in Oncologic Surgery: The Problem We All Live with

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