Jenny Wu1, Yongmei Huang2, Ana I Tergas3, Alexander Melamed4, Fady Khoury-Collado4, June Y Hou4, Caryn M St Clair4, Cande V Ananth5, Dawn L Hershman3, Jason D Wright6. 1. Columbia University College of Physicians and Surgeons, USA; Duke University, USA. 2. Columbia University College of Physicians and Surgeons, USA. 3. Columbia University College of Physicians and Surgeons, USA; Joseph L. Mailman School of Public Health, Columbia University, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA. 4. Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA. 5. Joseph L. Mailman School of Public Health, Columbia University, USA; Rutgers Robert Wood Johnson Medical School, USA; Environmental and Occupational Health Sciences Institute (EOHSI), USA. 6. Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA. Electronic address: jw2459@columbia.edu.
Abstract
OBJECTIVE: To evaluate whether the receipt of evidence-based care could mitigate survival disparities among Medicaid recipients and uninsured women with cervical cancer. METHODS: The National Cancer Database was utilized to identify women with cervical cancer treated from 2004 to 2016. Eight quality metrics were determined. Survival outcomes were examined stratified by insurance status and stage. To measure the impact of guideline-concordant care on the mitigation of disparities, we compared survival outcomes of the overall cohort to one that was perfectly adherent to all quality metrics. RESULTS: A total of 103,400 patients were identified; 47.0% of patients had private insurance, 21.5% Medicaid and 9.2% uninsured. Medicaid and uninsured patients were significantly less likely than privately insured patients to receive timely completion of radiation and timely initiation of treatment; uninsured patients were also significantly less likely to receive treatment for locally advanced disease. Medicaid and uninsured patients were also less likely to receive lymph node assessment and primary chemoradiation. Medicaid and uninsured patients had an increased risk of mortality compared to privately insured patients (aHR = 1.36, 95% CI 1.31-1.41 and aHR 1.29, 95% CI 1.23-1.36 respectively). While the receipt of these quality metrics was associated with improved survival, Medicaid and uninsured women who received guideline-concordant care were still at an increased risk of death compared to women with private insurance (aHR = 1.38, 95% CI 1.35-1.49 and aHR = 1.24; 95% CI, 1.16-1.32 respectively). CONCLUSION: Medicaid and uninsured patients were less likely to receive evidence-based care and were at increased risk of mortality at all stages compared to privately insured patients. The receipt of quality care does not eliminate insurance status-based disparities among women with cervical cancer.
OBJECTIVE: To evaluate whether the receipt of evidence-based care could mitigate survival disparities among Medicaid recipients and uninsured women with cervical cancer. METHODS: The National Cancer Database was utilized to identify women with cervical cancer treated from 2004 to 2016. Eight quality metrics were determined. Survival outcomes were examined stratified by insurance status and stage. To measure the impact of guideline-concordant care on the mitigation of disparities, we compared survival outcomes of the overall cohort to one that was perfectly adherent to all quality metrics. RESULTS: A total of 103,400 patients were identified; 47.0% of patients had private insurance, 21.5% Medicaid and 9.2% uninsured. Medicaid and uninsured patients were significantly less likely than privately insured patients to receive timely completion of radiation and timely initiation of treatment; uninsured patients were also significantly less likely to receive treatment for locally advanced disease. Medicaid and uninsured patients were also less likely to receive lymph node assessment and primary chemoradiation. Medicaid and uninsured patients had an increased risk of mortality compared to privately insured patients (aHR = 1.36, 95% CI 1.31-1.41 and aHR 1.29, 95% CI 1.23-1.36 respectively). While the receipt of these quality metrics was associated with improved survival, Medicaid and uninsured women who received guideline-concordant care were still at an increased risk of death compared to women with private insurance (aHR = 1.38, 95% CI 1.35-1.49 and aHR = 1.24; 95% CI, 1.16-1.32 respectively). CONCLUSION: Medicaid and uninsured patients were less likely to receive evidence-based care and were at increased risk of mortality at all stages compared to privately insured patients. The receipt of quality care does not eliminate insurance status-based disparities among women with cervical cancer.
Authors: Sarah P Huepenbecker; Shuangshuang Fu; Charlotte C Sun; Hui Zhao; Kristin M Primm; Sharon H Giordano; Larissa A Meyer Journal: Am J Obstet Gynecol Date: 2022-04-29 Impact factor: 10.693
Authors: Grace Lee; Edward Christopher Dee; E John Orav; Daniel W Kim; Paul L Nguyen; Alexi A Wright; Miranda B Lam Journal: Cancer Rep (Hoboken) Date: 2021-05-02