Effects of payer status on breast cancer survival: a retrospective study

BMC Cancer

Runhua Shi¹  Hannah Taylor²  Jerry McLarty¹  Lihong Liu¹  Glenn Mills¹  Gary Burton¹ 

[1] Department of Medicine & Feist-Weiller Cancer Center, LSU Health Shreveport, 1501 Kings Hwy, Shreveport 71103, LA, USA

[2] Feist-Weiller Cancer Center, LSU Health Shreveport, 1501 Kings Hwy, Shreveport 71103, LA, USA

关键词: Risk factors;    Insurance;    Payer status;    Survival;    Female breast cancer;   

Others  :  1161049
DOI  :  10.1186/s12885-015-1228-7

 received in 2014-07-29, accepted in 2015-03-19,  发布年份 2015

【 摘 要 】

Background

Breast cancer outcomes are influenced by multiple factors including access to care, and payer status is a recognized barrier to treatment access. To further define the influence of payer status on outcome, the National Cancer Data Base data from 1998–2006 was analyzed.

Method

Data was analyzed from 976,178 female patients diagnosed with breast cancer registered in the National Cancer Data Base. Overall survival was the primary outcome variable while payer status was the primary predictor variable. Secondary predictor variables included stage, age, race, Charlson Comorbidity index, income, education, distance travelled, cancer program, diagnosing/treating facility, and treatment delay. Multivariate Cox regression was used to investigate the effect of payer status on overall survival while adjusting for secondary predictive factors.

Results

Uninsured (28.68%) and Medicaid (28.0%) patients had a higher percentage of patients presenting with stage III and stage IV cancer at diagnosis. In multivariate analysis, after adjusting for secondary predictor variables, payer status was a statistically significant predictor of survival. Patients with private, unknown, or Medicare status showed a decreased risk of dying compared to uninsured, with a decrease of 36%, 22%, and 15% respectively. However, Medicaid patients had an increased risk of 11% compared to uninsured. The direct adjusted median overall survival was 14.92, 14.76, 14.56, 13.64, and 12.84 years for payer status of private, unknown, Medicare, uninsured, and Medicaid respectively.

Conclusion

We observed that patients with no insurance or Medicaid were most likely to be diagnosed at stage III and IV. Payer status showed a statistically significant relationship with overall survival. This remained true after adjusting for other predictive factors. Patients with no insurance or Medicaid had higher mortality.

【 授权许可】

   
2015 Shi et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Breast Cancer. [http://seer.cancer.gov/statfacts/html/breast.html]
• [2]Society. AC: Cancer Treatment and Survivorship Facts & Figures 2014–2015. American Cancer Society, Atlanta, Georgia; 2014.
• [3]SEER Cancer Statistics Review 1975–2011 [http://seer.cancer.gov/csr/1975_2011/browse_csr.php?sectionSEL=4&pageSEL=sect_04_table.05.html]
• [4]SEER Cancer Statistics Review 1975–2011 [http://seer.cancer.gov/csr/1975_2011/browse_csr.php?sectionSEL=4&pageSEL=sect_04_table.12.html]
• [5]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(3S):16s-21s.
• [6]Shi R, Mills G, McLarty J, Burton G, Shi Z, Glass J: Commercial insurance triples chances of breast cancer survival in a public hospital. Breast J 2013, 19(6):664-667.
• [7]Ward E, Halpern M, Schrag N, Cokkinides V, DeSantis C, Bandi P, et al.: Association of insurance with cancer care utilization and outcomes. CA Cancer J Clin 2008, 58(1):9-31.
• [8]Halpern MT, Bian J, Ward EM, Schrag NM, Chen AY: Insurance status and stage of cancer at diagnosis among women with breast cancer. Cancer 2007, 110(2):403-411.
• [9]Newman LA, Mason J, Cote D, Vin Y, Carolin K, Bouwman D, et al.: African-American ethnicity, socioeconomic status, and breast cancer survival: a meta-analysis of 14 studies involving over 10,000 African-American and 40,000 White American patients with carcinoma of the breast. Cancer 2002, 94(11):2844-2854.
• [10]Sabik LM, Bradley CJ: Differences in mortality for surgical cancer patients by insurance and hospital safety net status. Med Care Res Rev 2013, 70(1):84-97.
• [11]Niu X, Roche LM, Pawlish KS, Henry KA: Cancer survival disparities by health insurance status. Cancer Med 2013, 2(3):403-411.
• [12]DeSantis C, Jemal A, Ward E: Disparities in breast cancer prognostic factors by race, insurance status, and education. Cancer Cause Control 2010, 21(9):1445-1450.
• [13]Albano JD, Ward E, Jemal A, Anderson R, Cokkinides VE, Murray T, et al.: Cancer mortality in the united states by education level and race. J Natl Cancer Inst 2007, 99(18):1384-1394.
• [14]Shariff-Marco S, Yang J, John EM, Sangaramoorthy M, Hertz A, Koo J, et al.: Impact of Neighborhood and Individual Socioeconomic Status on Survival after Breast Cancer Varies by Race/Ethnicity: The Neighborhood and Breast Cancer Study. Cancer Epidem Biomar 2014, 23(5):793-811.
• [15]Patient Protection and Affordable Care Act, 42 U.S.C. § 18001 et seq. (2010). http://housedocs.house.gov/energycommerce/ppacacon.pdf
• [16]DeNavas-Walt, Carmen, Bernadette D. Proctor, and Jessica C. Smith, U.S. Census Bureau, Current Population Reports, P60-245, Income, Poverty, and Health Insurance Coverage in the United States: 2012, U.S. Government Printing Office, Washington, DC, 2013. https://www.census.gov/prod/2013pubs/p60-245.pdf
• [17]Lee-Feldstein A, Anton-Culver H, Feldstein PJ: Treatment differences and other prognostic factors related to breast cancer survival. Delivery systems and medical outcomes. JAMA 1994, 271(15):1163-1168.
• [18]Council. IoMaNR: Ensuring Quality Cancer Care. The National Academies Press, Washington, DC; 1999.
• [19]Chaudhry R, Goel V, Sawka C: Breast cancer survival by teaching status of the initial treating hospital. CMAJ 2001, 164(2):183-188.
• [20]Hartz AJ, Krakauer H, Kuhn EM, Young M, Jacobsen SJ, Gay G, et al.: Hospital characteristics and mortality rates. N Engl J Med 1989, 321(25):1720-1725.
• [21]Massarweh NN, Chiang YJ, Xing Y, Chang GJ, Haynes AB, You YN, et al.: Association Between Travel Distance and Metastatic Disease at Diagnosis Among Patients With Colon Cancer. J Clin Oncol 2014, 32(9):942 − +.
• [22]Klein J, Ji M, Rea NK, Stoodt G: Differences in male breast cancer stage, tumor size at diagnosis, and survival rate between metropolitan and nonmetropolitan regions. Am J Men's Health 2011, 5(5):430-437.
• [23]Doescher MP, Jackson JE: Trends in cervical and breast cancer screening practices among women in rural and urban areas of the United States. J Public Health Manage Pract 2009, 15(3):200-209.
• [24]Delgado DJ, Lin WY, Coffey M: The role of Hispanic race/ethnicity and poverty in breast cancer survival. P R Health Sci J 1995, 14(2):103-116.
• [25]Redondo M, Rodrigo I, Pereda T, Funez R, Acebal M, Perea-Milla E, et al.: Prognostic implications of emergency admission and delays in patients with breast cancer. Support Care Cancer 2009, 17(5):595-599.
• [26]Smith ER, Adams SA, Das IP, Bottai M, Fulton J, Hebert JR: Breast cancer survival among economically disadvantaged women: The influences of delayed diagnosis and treatment on mortality. Cancer Epidem Biomar 2008, 17(10):2882-2890.
• [27]McLaughlin JM, Anderson RT, Ferketich AK, Seiber EE, Balkrishnan R, Paskett ED: Effect on survival of longer intervals between confirmed diagnosis and treatment initiation among low-income women with breast cancer. J Clin Oncol 2012, 30(36):4493-4500.
• [28]Charlson ME, Pompei P, Ales KL, Mackenzie CR: A NEW METHOD OF CLASSIFYING PROGNOSTIC CO-MORBIDITY IN LONGITUDINAL-STUDIES - DEVELOPMENT AND VALIDATION. J Chronic Dis 1987, 40(5):373-383.
• [29]National Cancer Data Base [http://www.facs.org/cancer/ncdb/index.html]
• [30]Simon MS, Banerjee M, Crossley-May H, Vigneau FD, Noone AM, Schwartz K: Racial differences in breast cancer survival in the Detroit Metropolitan area. Breast Cancer Res Treat 2006, 97(2):149-155.
• [31]Albain KS, Unger JM, Crowley JJ, Coltman CA Jr, Hershman DL: Racial disparities in cancer survival among randomized clinical trials patients of the Southwest Oncology Group. J Natl Cancer Inst 2009, 101(14):984-992.
• [32]Rueth NM, Lin HY, Bedrosian I, Shaitelman SF, Ueno NT, Shen Y, et al.: Underuse of trimodality treatment affects survival for patients with inflammatory breast cancer: an analysis of treatment and survival trends from the national cancer database. J Clin Oncol 2014, 32(19):2018-2024.