Health insurance literacy, status, and financial toxicity in women receiving treatment for metastatic breast cancer.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 96-96
Author(s):  
Courtney Williams ◽  
Stacey A. Ingram ◽  
Valerie Lawhon ◽  
Clara Wan ◽  
Kelly Kenzik ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Insurance ◽  
Private Insurance ◽  
Metastatic Breast ◽  
Insurance Status ◽  
Financial Toxicity ◽  
Health Insurance Status ◽  
Health Insurance Literacy ◽  
Insured Patients ◽  
Privately Insured

96 Background: Though uninsurance rates declined after the Affordable Care Act, the number of underinsured, or individuals who spend > 10% of their income on out-of-pocket (OOP) medical costs, continues to rise. In patients with metastatic breast cancer (MBC), underinsurance may lead to financial toxicity (FT), or patient-level financial burden and distress, since diagnosis and treatment is extremely costly. This study explores health insurance literacy and the association between FT and health insurance status in women receiving treatment for MBC. Methods: This cross-sectional study utilized survey data collected from 2017-2019 in women age ≥18 receiving treatment for MBC at two academic medical centers in Alabama. FT was measured by the Comprehensive Score for Financial Toxicity (COST) tool (11-item scale from 0-44, with lower scores indicating worse FT). Health insurance status and OOP costs were self-reported. Effect sizes were calculated using Cohen’s d or Cramer’s V. Mixed and generalized linear models clustered by site and treating medical oncologist estimated the association between FT and health insurance status. Results: In 81 women with MBC, median COST score was 24 (interquartile range [IQR] 17-30), 44% had private insurance, 40% Medicare, and 16% Medicaid. Though 25% and 33% of surveyed patients did not know their health insurance premium or deductible cost, respectively, privately insured patients more often knew the cost of their premiums (97%; V = 0.58) and deductibles (81%; V = 0.33) compared to publicly insured patients. In adjusted models, FT levels did not differ significantly based on health insurance type (private insurance COST 21, 95% confidence interval [CI] 18-25; Medicaid COST 23, 95% CI 17-29; Medicare COST 24, 95% CI 20-27). However, risk of severe FT (COST ≤13) was 147% higher for privately insured patients versus Medicare beneficiaries (risk ratio 2.47, 95% CI 1.44-4.21). Conclusions: Despite higher levels of health insurance literacy, privately insured patients receiving treatment for MBC may be at increased risk of severe FT. Further research is needed to understand causes of underinsurance in patients with MBC, which could lead to cancer-related FT.

Health Insurance Literacy and Financial Hardship in Women Living With Metastatic Breast Cancer

2020 ◽  
Vol 16 (6) ◽  
pp. e529-e537 ◽  
Author(s):  
Courtney P. Williams ◽  
Maria Pisu ◽  
Andres Azuero ◽  
Kelly M. Kenzik ◽  
Ryan D. Nipp ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Insurance ◽  
Metastatic Breast Cancer ◽  
Private Insurance ◽  
Metastatic Breast ◽  
Lifestyle Changes ◽  
Financial Hardship ◽  
Financial Toxicity ◽  
Medical Test ◽  
Health Insurance Literacy

PURPOSE: In patients with metastatic breast cancer (MBC), low health insurance literacy may be associated with adverse material conditions, psychological response, and coping behaviors because of financial hardship (FH). This study explored the relationship between health insurance literacy and FH in women with MBC. METHODS: This cross-sectional study used data collected from 84 women receiving MBC treatment at 2 southeastern cancer centers. Low health insurance literacy was defined as not knowing premium or deductible costs. FH was defined by lifestyle changes as a result of medical expenses, financial toxicity, and medical care modifications attributable to cost. Mean differences were calculated using Cramer’s V. Associations between health insurance literacy and FH were estimated with adjusted linear models. RESULTS: Half of the surveyed patients had low health insurance literacy, 26% were underinsured, 45% had private insurance, 39% had Medicare, and 15% had Medicaid. Patients with low health insurance literacy more often reported borrowing money (19% v 4%; V = 0.35); an inability to pay for basic necessities like food, heat, or rent (10% v 4%; V = 0.18); and skipping a procedure (8% v 1%; V = 0.21), medical test (7% v 0%; V = 0.30), or treatment (4% v 0%; V = 0.20) compared with patients with high health insurance literacy. Median Comprehensive Score for Financial Toxicity was 23 (interquartile range, 17-29). In adjusted models, health insurance literacy was not associated with financial toxicity. CONCLUSION: Low health insurance literacy was common in women receiving MBC treatment. Additional research to increase health insurance literacy could lessen undesirable material FH and unnecessary behavioral FH associated with cancer-related care.

scholarly journals Association between health insurance status and malignant glioma

2020 ◽  
Vol 7 (5) ◽  
pp. 531-540
Author(s):  
Igor Fischer ◽  
Hendrik-Jan Mijderwijk ◽  
Ulf D Kahlert ◽  
Marion Rapp ◽  
Michael Sabel ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Health Insurance ◽  
Brain Tumors ◽  
Malignant Neoplasms ◽  
German Population ◽  
Insurance Status ◽  
Health Insurance Status ◽  
Neurosurgical Patients ◽  
Insured Patients ◽  
Privately Insured

Abstract Background Prior studies have suggested an association between patient socioeconomic status and brain tumors. In the present study we attempt to indirectly validate the findings, using health insurance status as a proxy for socioeconomic status. Methods There are 2 types of health insurance in Germany: statutory and private. Owing to regulations, low- and middle-income residents are typically statutory insured, whereas high-income residents have the option of choosing a private insurance. We compared the frequencies of privately insured patients suffering from malignant neoplasms of the brain with the corresponding frequencies among other neurosurgical patients at our hospital and among the German population. To correct for age, sex, and distance from the hospital, we included these variables as predictors in logistic and binomial regression. Results A significant association (odds ratio [OR] = 1.59, CI = 1.45-1.74, P < .001) between health insurance status and brain tumors was found. The association is independent of patients’ sex or age. Whereas privately insured patients generally tend to come from farther away, such a relationship was not observed for patients suffering from brain tumors. Comparing the out of house and in-house brain tumor patients showed no selection bias on our side. Conclusion Previous studies have found that people with a higher income, level of education, or socioeconomic status are more likely to suffer from malignant brain tumors. Our findings are in line with these studies. Although the reason behind the association remains unclear, the probability that our results are due to some random effect in the data is extremely low.

scholarly journals Stalled at the Intersection: Insurance Status and Disparities in Post Mastectomy Breast Reconstruction

2021 ◽  
Author(s):  
Orli Friedman-Eldar ◽  
Jonathan Burke ◽  
Iago de Castro Silva ◽  
Camille C Baumrucker ◽  
Fernando Valle ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Logistic Regression ◽  
Breast Reconstruction ◽  
Private Insurance ◽  
Safety Net ◽  
Insurance Status ◽  
Multivariable Logistic Regression ◽  
Safety Net Hospital ◽  
Insured Patients ◽  
Privately Insured

Abstract PurposePost-mastectomy breast reconstruction (PMBR) is an important component of breast cancer treatment, but disparities relative to insurance status persist despite legislation targeting the issue. We aimed to study this relationship in a large health system combining a safety net hospital and a private academic center.MethodsData were collected on all patients who underwent mastectomy for breast cancer from 2011-2019 in a private academic center and an adjacent public safety-net hospital served by same surgical teams. Multivariable logistic regression was used to assess the effect of insurance status on PMBR, controlling for covariates that included socioeconomic, demographic, and clinical factors.ResultsOf 1,554 patients undergoing mastectomy for breast cancer, 753 (48.5%) underwent PMBR. Out of them, 741 had insurance type recorded, with 592 (79.9%) privately insured patients, 50 (6.7%) Medicare, 68 (9.2%) Medicaid, and 31 (4.2%) uninsured patients. Multivariable logistic regression showed a significantly lower likelihood of undergoing PMBR for uninsured (OR 6.9, 95% CI: 4.1-11.7; p<0.0001), Medicare (OR 2.0, (5% CI: 1.2-3.3; p=0.004), and Medicaid (OR 1.7, 95% CI:1.1-2.7; p=0.02) patients, compared with privately insured patients. Age, stage, race, and hospital type confounded this relationship.ConclusionPatients without health insurance have dramatically reduced access to PMBR compared to those with private insurance. Expanding access to this important procedure is essential to achieve greater health equity for breast cancer patients.

Cancer-related financial burden among patients with metastatic breast cancer.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 32-32 ◽  
Author(s):  
Stephanie B. Wheeler ◽  
Jennifer Spencer ◽  
Michelle L. Manning ◽  
Cleo A. Samuel ◽  
Katherine Elizabeth Reeder-Hayes ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Insurance ◽  
Metastatic Breast Cancer ◽  
Cancer Patients ◽  
Financial Burden ◽  
Metastatic Breast ◽  
Financial Impact ◽  
Insurance Status ◽  
Breast Cancer Patients ◽  
Health Insurance Status

32 Background: Recent data suggest that the adverse financial impact of cancer is an underappreciated source of potential harm to patients, also known as “financial toxicity”. Little is known about the financial impact of cancer in patients with widespread, incurable disease, despite the relatively high cost of their care. We conducted a national survey of patients with metastatic breast cancer to address this gap. Methods: We partnered with the Metastatic Breast Cancer Network to field an online survey of metastatic breast cancer patients over a fourteen-day period using Qualtrics. The survey required approximately 20 minutes to complete, and participants were offered a $10 Amazon gift card. Survey items included sociodemographic information, health insurance status, cost-related communication with providers, post-treatment financial burden, financial coping strategies, and emotional well-being. We report financial outcomes stratified by health insurance status, as insurance is an important protective mechanism against health-related financial shocks. Results: 1,513 participants responded from 41 states. More than a third of these women (35%) were uninsured. Uninsured individuals more often reported refusing or delaying treatment due to cost (98% vs. 41% of insured, p < .001) and were also more likely to report skipping non-medical bills (40% vs. 16%, p < .001), stopping work after diagnosis (65% vs. 46%, p < .001), or being contacted by a collections agency (77% vs. 36%, p < .001). Despite this, insured participants reported higher cost-related emotional distress, including being “quite a bit” or “very” stressed about not knowing cancer costs (53% vs. 32%, p < .001) and about financial stress on their family due to their cancer (52% vs. 27%, p < .001). Conclusions: Metastatic breast cancer patients reported an unprecedented level of cancer-related financial harm and significant worry about the financial legacy left behind in the wake of their illness. Health insurance expansion is a necessary, but insufficient strategy to address this financial burden; additional interventions to prevent and mitigate cancer-related financial harm are urgently needed.

scholarly journals Survival in Women with De Novo Metastatic Breast Cancer: A Comparison of Real-World Evidence from a Publicly-Funded Canadian Province and the United States by Insurance Status

2022 ◽  
Vol 29 (1) ◽  
pp. 383-391
Author(s):  
Marie-France Savard ◽  
Elizabeth N. Kornaga ◽  
Adriana Matutino Kahn ◽  
Sasha Lupichuk
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Metastatic Breast Cancer ◽  
De Novo ◽  
Private Insurance ◽  
Metastatic Breast ◽  
The United States ◽  
Insurance Status ◽  
The Us ◽  
Privately Insured

Metastatic breast cancer (MBC) patient outcomes may vary according to distinct health care payers and different countries. We compared 291 Alberta (AB), Canada and 9429 US patients < 65 with de novo MBC diagnosed from 2010 through 2014. Data were extracted from the provincial Breast Data Mart and from the National Cancer Institute’s SEER program. US patients were divided by insurance status (US privately insured, US Medicaid or US uninsured). Kaplan-Meier and log-rank analyses were used to assess differences in OS and hazard ratios (HR) were estimated using Cox models. Multivariate models were adjusted for age, surgical status, and biomarker profile. No difference in OS was noted between AB and US patients (HR = 0.92 (0.77–1.10), p = 0.365). Median OS was not reached for the US privately insured and AB groups, and was 11 months and 8 months for the US Medicaid and US uninsured groups, respectively. The 3-year OS rates were comparable between US privately insured and AB groups (53.28% (51.95–54.59) and 55.54% (49.49–61.16), respectively). Both groups had improved survival (p < 0.001) relative to the US Medicaid and US uninsured groups [39.32% (37.25–41.37) and 40.53% (36.20–44.81)]. Our study suggests that a universal health care system is not inferior to a private insurance-based model for de novo MBC.

Health insurance status and cancer stage at diagnosis and survival in the United States.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 7026-7026
Author(s):  
Jingxuan Zhao ◽  
Xuesong Han ◽  
Leticia Nogueira ◽  
Ahmedin Jemal ◽  
Michael T. Halpern ◽  
...  
Keyword(s):  
Health Insurance ◽  
Cancer Site ◽  
Insurance Status ◽  
Advanced Stage ◽  
Stage At Diagnosis ◽  
Uninsured Patients ◽  
Health Insurance Status ◽  
Access To Health ◽  
Insured Patients ◽  
Privately Insured

7026 Background: While previous studies demonstrated associations between Medicaid coverage or no health insurance with both advanced stage at cancer diagnosis and worse survival, access to health care in the U.S. has changed substantially in the past decade. This study examined associations of health insurance status with stage at diagnosis and survival among 17 common cancers using recent national data. Methods: We identified 1,427,532 cancer patients aged 18-64 years newly diagnosed with 17 common cancers from the 2010-2013 National Cancer Database. Multivariable logistic regression models were used to examine the distribution of stage at diagnosis by health insurance status (private, Medicare, Medicaid, dual Medicare/Medicaid, and uninsured) overall and for each cancer site. Cox models compared stage-specific survival by health insurance for each site. Results: Compared to privately insured patients, Medicaid and uninsured patients were significantly more likely to be diagnosed with advanced-stage cancer (III/IV) for all the 17 cancers combined (adjusted odds ratio [AOR]: 2.27, 95% confidence interval [95CI]: 2.24-2.29; AOR: 2.39, 95CI: 2.36-2.42, respectively) and for all included cancer sites separately. Medicare and Medicare-Medicaid patients were also more likely to be diagnosed at advanced-stage for all the 17 cancers combined, but results varied by cancer site. Compared to the privately insured patients, worse survival was observed for patients with all other insurance types and uninsured at each stage for all the 17 cancers combined and most cancer sites. For example, among patients diagnosed at stage I, adjusted mortality hazard ratios for Medicare, Medicaid, Medicare-Medicaid, and uninsured patients were 1.72 (95CI: 1.70-1.75), 1.73 (95CI: 1.71-1.76), 2.07 (95CI: 2.02-2.17) and 1.56 (95CI: 1.53-1.58), respectively, compared with privately-insured patients. Conclusions: Patients with non-private insurance were more likely to be diagnosed with cancer at advanced stage and have worse survival. Improving access to health insurance with adequate coverage is crucial for receiving appropriate cancer screening, diagnosis, and quality care.

scholarly journals Interrelationship Between Health Insurance Status and Prostate Cancer Grade Can Have Critical Impact on Prostate Cancer Disease Control: A Retrospective Cohort Study

2019 ◽  
Vol 26 (1) ◽  
pp. 107327481983718
Author(s):  
Shivanshu Awasthi ◽  
Travis Gerke ◽  
Vonetta L. Williams ◽  
Francis Asamoah ◽  
Angelina K. Fink ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Health Insurance ◽  
Disease Control ◽  
Specific Antigen ◽  
Low Grade ◽  
Insurance Status ◽  
Cancer Disease ◽  
Health Insurance Status ◽  
Private And Public ◽  
Insured Patients

The extent to which prostate cancer (PCa) pathology interacts with health insurance to predict PCa outcomes remains unclear. This study will assess the overall association of health insurance on PCa disease control and analyze its interrelationship PCa pathology. A total of 674 PCa patients, treated with prostatectomy from 1987 to 2015, were included in the study. Freedom from biochemical failure (FFbF) was used as a measure of PCa disease control. Methods of categorical and survival analysis were used to analyze the relationships between health insurance, PCa pathology, and FFbF. A total of 63.3% patients were privately insured, 27.1% were publicly insured, and 9.5% were uninsured. In a multivariable model, privately (hazard ratio [HR] = 0.64, 95% confidence interval [CI]: 0.42-0.97, P = .03) and publicly (HR = 0.65, 95% CI: 0.41-1.04, P = .07) insured patients showed improvement in FFbF compared to uninsured patients. The association of health insurance was significantly stronger for the patients with pathologically low grade PCa (pathologic Gleason Score 3+3 & preoperative prostate-specific antigen ≤10 ng/mL), likelihood ratio P = .009. Privately (HR = 0.22, 95% CI: 0.10-0.46) or publicly (HR = 0.26, 95% CI: 0.11-0.60) insured patients with low grade PCa demonstrated favorable association with FFbF. Patients with private and public insurance were more likely to experience favorable treatment. The association of health insurance on PCa disease control is significantly stronger among patients with pathologically low grade PCa. This study identifies health insurance status as pretreatment surrogate for PCa disease control.

scholarly journals Age-related Differences in Breast Cancer Mortality according to Race/Ethnicity, Insurance, and Socioeconomic Status

2019 ◽  
Author(s):  
Yazmin San Miguel ◽  
Scarlett Lin Gomez ◽  
James D. Murphy ◽  
Richard B. Schwab ◽  
Corinne McDaniels-Davidson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Socioeconomic Status ◽  
Health Insurance ◽  
Cancer Mortality ◽  
Breast Cancer Mortality ◽  
Insurance Status ◽  
Younger Patients ◽  
Younger Women ◽  
Health Insurance Status ◽  
Race Ethnicity

Abstract Purpose We assessed breast cancer mortality in older versus younger women according to race/ethnicity, neighborhood socioeconomic status (nSES), and health insurance status. Methods The study included female breast cancer cases 18 years of age and older, diagnosed between 2005 and 2015 in the California Cancer Registry. Multivariable Cox proportional hazards modeling was used to generate hazard ratios (HR) of breast cancer specific deaths and 95% confidence intervals (CI) for older (60+ years) versus younger (<60 years) patients separately by race/ethnicity, nSES, and health insurance status. Results Risk of dying from breast cancer was higher in older than younger patients after multivariable adjustment, which varied in magnitude by race/ethnicity (P-interaction<0.0001). Comparing older to younger patients, higher mortality differences were shown for non-Hispanic white (HR=1.43; 95% CI, 1.36-1.51) and Hispanic women (HR=1.37; 95% CI, 1.26-1.50) and lower differences for non-Hispanic blacks (HR=1.17; 95% CI, 1.04-1.31) and Asians/Pacific Islanders (HR=1.15; 95% CI, 1.02-1.31). HRs comparing older to younger patients varied by insurance status (P-interaction<0.0001), with largest mortality differences observed for privately insured women (HR=1.51; 95% CI, 1.43-1.59) and lowest in Medicaid/military/other public insurance (HR=1.18; 95% CI, 1.10-1.26). No age differences were shown for uninsured women. HRs comparing older to younger patients were similar across nSES strata. Conclusion Our results provide evidence for the continued disparity in black-white breast cancer mortality, which is magnified in younger women. Moreover, insurance status continues to play a role in breast cancer mortality, with uninsured women having the highest risk for breast cancer death, regardless of age.

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