Impact of Medicaid expansion on two-year mortality among stage IV breast cancer (BC) patients according to race.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6525-6525
Author(s):  
Catalina Malinowski ◽  
Xiudong Lei ◽  
Hui Zhao ◽  
Sharon H. Giordano ◽  
Mariana Chavez Mac Gregor
Keyword(s):  
Breast Cancer ◽  
Low Income ◽  
Stage Iv ◽  
Medicaid Expansion ◽  
Risk Of Death ◽  
Stage Iv Breast Cancer ◽  
Increased Risk ◽  
The Impact ◽  
Expansion Period ◽  
White Patients

6525 Background: Inadequate access to healthcare services is associated with worse outcomes. Disparities in access to cancer care are more frequently seen among racial/ethnic minorities, uninsured patients, and those with low socioeconomic status. A provision in the Affordable Care Act called for expansion of Medicaid eligibility in order to cover more low-income Americans. In this study, we evaluate the impact of Medicaid expansion in 2-year mortality among metastatic BC patients according to race. Methods: Women (aged 40-64) diagnosed with metastatic BC (stage IV de novo) between 01/01/2010 and 12/31/2015 and residing in states that underwent Medicaid expansion in 01/2014 were identified in the National Cancer Database. For comparison purposes, 2010-2013 was considered the pre-expansion period and 2014-2015 the post-expansion period. We calculated 2-year mortality difference-in-difference (DID) estimates between White and non-White patients using multivariable linear regression models. Results are presented as adjusted differences (in % points) between groups in the pre- and post-expansion periods and as adjusted DID with 95%CI. Covariates included age, comorbidity, BC subtype, insurance type, transfer of care, distance to hospital, region, residence area, education, income quartile, facility type and facility volume. In addition, overall survival (OS) was evaluated in pre- and post-expansion periods via Kaplan-Meier method and Cox proportional hazards models; results are presented as 2-year OS estimates, hazard ratios (HRs), and 95% CIs. Results: Among 7,675 patients included, 4,942 were diagnosed in the pre- and 2,733 in the post-expansion period. We observed a reduction in 2-year mortality rates in both groups according to Medicaid expansion. Among Whites 2-year mortality decreased from 42.5% to 38.7% and among non-Whites from 45.4% to 36.4%, resulting in an adjusted DID of -5.2% (95%CI -9.8 to -0.6, p = 0.027). A greater reduction in 2-year mortality was observed among non-Whites in a sub-analysis of patients who resided in the poorest quartile (n = 1372), with an adjusted DID of -14.6% (95%CI -24.8 to -4.4, p = 0.005). In the multivariable Cox model, during the pre-expansion period there was an increased risk of death for non-Whites compared to Whites (HR 1.14, 95% CI 1.03 to 1.26, P = 0.04), however no differences were seen in the post-expansion period between the two groups (HR 0.93, 95% CI 0.80 to 1.07, P = 0.31). Conclusions: Medicaid expansion reduced racial disparities by decreasing the 2-year mortality of non-White patients with metastatic breast cancer and reducing the gap when compared to Whites. These results highlight the positive impact of policies aimed at improving equity and increasing access to health care.

Impact of surgery and radiation of the primary among women with de novo stage IV breast cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 1032-1032
Author(s):  
Shaheenah S. Dawood ◽  
Rebecca Alexandra Dent ◽  
Sudeep Gupta ◽  
Jennifer Keating Litton ◽  
Rashid Mustafa ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Tumor ◽  
De Novo ◽  
Stage Iv ◽  
Primary Breast Tumor ◽  
Risk Of Death ◽  
Stage Iv Breast Cancer ◽  
Increased Risk ◽  
The Impact

1032 Background: The aim of this retrospective study was to determine the impact of surgery(S) and radiation(R) therapy to the primary tumor among patients (pts) with stage IV denovo breast cancer. Methods: The SEER registry was used to identify pts with denovo stageIV breast cancer diagnosed between 1988 and 2008. Pts were divided into 4 groups based on type of treatment to primary tumor: both S+R, S alone, R alone, or no treatment of primary (no S/R). Breast cancer specific survival (BCS) was calculated from the date of diagnosis of breast cancer to the date of death from breast cancer or last follow up. Survival outcomes were estimated by the Kaplan-Meier method, and Cox models were fit to determine the association between treatment of primary and survival after adjusting for potential confounders (e.g age, grade, hormone receptor and race). Results: 25903 pts were identified; 4640 (17.9%) S+R, 6556 (25.3%) S, 4467 (17.2%) R, and 10240 (39.5%) no S/R. 1183 (4.6%) had surgery to sites other than the primary. Median age was 63 years. Median follow-up was 14 months. Median BCS was 23 months. Median BCS among pts who underwent S+R, S, R and no S/R was 36 months, 31 months, 18 months and 15 months respectively (p<0.0001). Among pts who underwent S+R, median BCS among pts who did and did not have surgery to sites other than primary was 50 months and 41 months respectively (p=0.029). Of the pts treated with S+R 10-year BCS was 18%. In the multivariable model compared to women who were in the no S/R group those who underwent S (HR= 0.59, 95%CI 0.55- 0.62,p<0.0001) and S+R (HR=0.51, 95%CI 0.47-0.55,p<0.0001) had decreased risk of death from breast cancer and those who underwent R (HR=1.13, 95% CI 1.04-1.21, p=0.002) had an increased risk of death from breast cancer. Pts who had surgery to sites other than the primary tumor had decreased risk of death from breast cancer compared to those who did not (HR=0.80, 95%CI 0.72-0.89,p<0.0001). Conclusions: Our results indicate that S+R of the primary breast tumor among pts with denovo stage IV breast cancer maybe associated with a decreased risk of death from breast cancer. A select subgroup of pts who undergo S+R may also benefit from surgery to sites other than the primary which may afford them maximum survival advantage.

scholarly journals Trends in Survival Over the Past Two Decades Among White and Black Patients With Newly Diagnosed Stage IV Breast Cancer

2008 ◽  
Vol 26 (30) ◽  
pp. 4891-4898 ◽  
Author(s):  
Shaheenah Dawood ◽  
Kristine Broglio ◽  
Ana M. Gonzalez-Angulo ◽  
Aman U. Buzdar ◽  
Gabriel N. Hortobagyi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Stage Iv ◽  
The United States ◽  
Breast Cancer Specific Survival ◽  
Newly Diagnosed ◽  
Cancer Specific Survival ◽  
Risk Of Death ◽  
Black Patients ◽  
Stage Iv Breast Cancer ◽  
White Patients

Purpose Overall, breast cancer mortality has been declining in the United States, but survival studies of patients with stage IV disease are limited. The aim of this study was to evaluate trends in and factors affecting survival in a large population-based cohort of patients with newly diagnosed stage IV breast cancer. Patients and Methods We searched the Surveillance, Epidemiology, and End Results registry to identify female patients with stage IV breast cancer diagnosed between 1988 and 2003. Patients were divided into three groups according to year of diagnosis (1988 to 1993, 1994 to 1998, and 1999 to 2003). Survival outcomes were estimated by the Kaplan-Meier method, and Cox models were fit to determine the characteristics independently associated with survival. Results We identified 15,438 patients. Median age was 62 years. Median follow-up was 16 months, 18 months, and 11 months in periods 1988 to 1993, 1994 to 1998, and 1999 to 2003, respectively. Median breast cancer–specific survival was 23 months. In the multivariate model, earlier year of diagnosis, grade 3 disease, increasing age, being unmarried, hormone receptor–negative disease, and no surgery were all independently associated with worse overall and breast cancer–specific survival. With each successive year of diagnosis, black patients had an increasingly greater risk of death compared with white patients (hazard ratio, 1.03; 95% CI, 1.00 to 1.06; P = .031). Conclusion The survival of patients with newly diagnosed stage IV breast cancer has modestly improved over time, but these data suggest that the disparity in survival between black and white patients has increased.

Impact of Medicaid expansion on pancreatic cancer care: A difference-in-difference analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18567-e18567
Author(s):  
Ahmad Hamad ◽  
Mariam Eskander ◽  
Yaming Li ◽  
Oindrila Bhattacharyya ◽  
James L Fisher ◽  
...  
Keyword(s):  
Low Income ◽  
Early Stage ◽  
Ductal Adenocarcinoma ◽  
Control Group ◽  
Medicaid Expansion ◽  
Difference In Difference ◽  
Post Surgery ◽  
Number Of Patients ◽  
The Impact ◽  
Expansion Period

e18567 Background: The Affordable Care Act (ACA) increased insurance coverage for low-income individuals, which should potentially lead to better access to care and improved oncological outcomes. This study seeks to evaluate the impact of Medicaid expansion (ME) on care for pancreatic ductal adenocarcinoma (PDAC). Methods: Patients who were uninsured or on Medicaid and diagnosed with PDAC between 2004 and 2017 were queried from the National Cancer Database (NCDB). Two different expansion cohorts were included: early expansion states and 2014 expansion states. For early expansion states, the time period of pre-expansion was 2004-2009 and post-expansion was 2010-2017. As for the 2014 expansion states, the pre-expansion period was from 2004-2013 and post-expansion period was from 2014-2017. Patients in non-expansion states formed the control group. A difference-in-difference (DID) analysis was used to assess the association of ME with stage of diagnosis, treatment and survival for each expansion cohort. Results: In both early and January 2014 expansion states, there was an increase in overall Medicaid coverage (Early: DID = 0.29, 2014: DID = 0.37; P < 0.001), in particular for non-Hispanic Black and Hispanic Black patients (Non-Hispanic Black: Early: DID = 0.11, 2014: DID = 0.11; P < 0.001, Hispanic-Black: 2014: DID = 0.20; P = 0.003). There were no differences in early stage diagnosis (Early: DID = 0.02, 2014: DID = -0.02; P > 0.05). There was an increase in the number of patients receiving surgery (Early: DID = 0.05; P = 0.001, 2014: DID = 0.03; P = 0.029) but no difference in time to surgery among patients receiving surgery upfront (Early: DID = 1.75, 2014: DID = 0.38; P > 0.05). There was no difference in 30-day readmission post-surgery (Early: DID = 0.003; 2014: DID = -0.00007; P > 0.05) or 90-day mortality (Early: DID = -0.007, 2014: DID = -0.035; P > 0.05). Moreover, there was no difference in receipt of chemotherapy (Early: DID = 0.01, 2014: DID = 0.005; P > 0.05) or time to chemotherapy for patients receiving neoadjuvant chemotherapy (Early: Early: DID = 9.62, 2014: DID = 0.01; P > 0.05). Finally, there was no difference in receipt of palliative care among stage IV patients in both cohorts (Early: DID = -0.004, 2014: DID = 0.004; P > 0.05). Conclusions: This study suggests that after ME, PDAC patients were more likely to be insured and had increased access to surgical care. Future, studies should evaluate the implications of improved surgical access on clinical outcomes such as mortality.

The Impact of Primary Tumor Surgery on Survival in HER2 Positive Stage IV Breast Cancer Patients in the Current Era of Targeted Therapy

2020 ◽  
Vol 27 (8) ◽  
pp. 2711-2720 ◽  
Author(s):  
Ross Mudgway ◽  
Carlos Chavez de Paz Villanueva ◽  
Ann C. Lin ◽  
Maheswari Senthil ◽  
Carlos A. Garberoglio ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Targeted Therapy ◽  
Cancer Patients ◽  
Primary Tumor ◽  
Stage Iv ◽  
Tumor Surgery ◽  
Breast Cancer Patients ◽  
Her2 Positive ◽  
Stage Iv Breast Cancer ◽  
The Impact

The impact of primary surgery on stage IV breast cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 1113-1113
Author(s):  
Ella Harris ◽  
Malcolm R. Kell ◽  
Reem Salman ◽  
Maurice Stokes ◽  
Tom Gorey
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Stage Iv ◽  
Primary Carcinoma ◽  
Primary Surgery ◽  
Primary Disease ◽  
Stage Iv Breast Cancer ◽  
Stage Iv Disease ◽  
The Impact

1113 Background: The role of primary surgery in metastatic breast cancer is unclear. Here in we have performed metaanalysis on available data to assess the role of surgery on oncological outcome in patients with stage IV breast cancer. Methods: A comprehensive search for published trials that examined outcome following removal of primary disease in stage IV breast cancer was performed using MEDLINE and cross referencing available data. Reviews of each study were conducted, and data were extracted. Primary outcome was overall survival related to surgical removal of primary disease. Results: We identified 15 relevant studies of which 10 were appropriate for analysis. Data was available on 28,693 patients with stage IV disease, of whom 52.8% underwent removal of the primary carcinoma. Patients undergoing primary surgery in this setting were more likely to be alive at 3 years 40% vs. 22% (OR 2.32 CI 2.08-2.6, p<0.01 (surgery vs. no surgery)). Analysis of subgroups for selection to surgery or not, favoured smaller tumours, fewer comorbidities, fewer metastases (p<0.01). There was no difference between the two groups in location of metastases, grade of tumour or receptor status. Conclusions: Patients undergoing removal of primary carcinoma in the setting of stage IV breast cancer appear to have an improved overall survival. However the available data suggest that these surgical patients probably have better prognosis stage IV disease than those patients not undergoing surgery.

On the road again: Travel patterns and outcomes in rectal cancer.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 530-530
Author(s):  
Mary Kledzik ◽  
Anthony Joseph Scholer ◽  
Adam Khader ◽  
Juan Santamaria-Barria ◽  
Trevan D Fischer ◽  
...  
Keyword(s):  
Hospital Volume ◽  
Rectal Adenocarcinoma ◽  
Stage Iv ◽  
Travel Distance ◽  
Stage I ◽  
Factors Associated ◽  
Risk Of Death ◽  
Improved Outcomes ◽  
Increased Risk ◽  
The Impact

530 Background: Associations between high volume centers and outcomes have many advocating for centralization of cancer care, which can lead to increased travel, patient burden, and cost. There is, however, some conflicting data regarding outcomes for patients with more advanced disease. This study aims to explore factors associated with travel and the impact on survival for patients receiving surgery for rectal adenocarcinoma. Methods: All patients >18 years of age with rectal adenocarcinoma that had a surgical resection were identified using the National Cancer Database from 2004-2014. Univariate and multivariate (MV) regression analyses determined factors associated with increased travel distance (<50 miles, 50-100 miles, >100 miles) as well as the impact of travel on overall survival (OS). Results: Of 83,933 patients, those that traveled the furthest were more commonly younger, white non-Hispanic, insured, and with less comorbidities (all p<0.05 on MV analysis). Cancer stage, surgical approach, and type of surgery were not associated with travel distance (p=NS). Increased travel distance improved 5-year OS for stage IV disease (10%, p=0.002), and trended toward significance for stage II (4.0%, p=0.06) and stage 1 (4.3%, p=0.09) disease. After controlling for other factors, travel distance did not impact OS for stage II/III disease, but stage I and IV patients traveling 50-100 miles had an increased risk of death (stage I HR 1.16, CI 1.04-1.30; stage IV HR 1.19, CI 1.07-1.32). This was similar in the entire cohort where traveling 50-100 miles had an increased risk of death (HR 1.09; CI 1.03-1.14). Patients treated at non-low volume centers did have improved outcomes across all stages (p<0.01). Patients treated in academic hospitals had improved outcomes in stages I and IV (p=0.02). Conclusions: Younger, white, non-Hispanic patients are most likely to travel longer distances for rectal cancer treatment, regardless of stage. Increased hospital volume improves OS while travel and use of academic centers may impact patients with stage I/IV disease. Educating patients and providers regarding the influence of travel and hospital volume could help reallocate some resources, decrease financial toxicity, and ease the travel burden for patients.

scholarly journals The impact of surgical excision of the primary tumor in stage IV breast cancer on survival: a meta-analysis

Oncotarget ◽  
2017 ◽  
Vol 9 (14) ◽  
pp. 11816-11823 ◽  
Author(s):  
Shuangshuang Lu ◽  
Jiayi Wu ◽  
Yan Fang ◽  
Wei Wang ◽  
Yu Zong ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Tumor ◽  
Meta Analysis ◽  
Stage Iv ◽  
Surgical Excision ◽  
Stage Iv Breast Cancer ◽  
The Impact

Determinants of functional disability in stage IV breast cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 9567-9567
Author(s):  
A. L. Cheville ◽  
J. Basford ◽  
A. Troxel ◽  
A. Kornblith
Keyword(s):  
Breast Cancer ◽  
Mental Health ◽  
Functional Disability ◽  
Stage Iv ◽  
Community Dwelling ◽  
Functional Domains ◽  
Pleural Effusions ◽  
Physical Impairments ◽  
Stage Iv Breast Cancer ◽  
The Impact

9567 Background: Functional disability degrades cancer patients' quality of life, exhausts caregivers and incurs significant expense yet little is know of the factors that contribute to disablement or whether the impact of these factors differs across functional domains. Better understanding of the influence that symptoms, physical impairments, and disease characteristics exert on disablement is needed in order to develop service delivery models that preserve function. Methods: To identify factors that influence functional performance in community dwelling people with stage IV breast cancer we conducted a cross-sectional study in a tertiary medical center outpatient cancer clinic. A consecutive sample of 163 community-dwelling patients with stage IV breast cancer were administered self- and clinician-rated functional metrics covering multiple domains including overall functioning, mobility, and self care. Self report measures included the Medical Outcomes Study Physical Function Subscale (PF-10) and the Older Americans Resource Study (OARS) Activities of Daily Living (ADL) and Instrumental ADL (IADL) subscales, and clinician report measures included the Karnofsky Performance Scale (KPS) and the Functional Independence Measure (FIM) Total and Mobility scores. Pain and mental health were assessed through administration of the Brief Pain Inventory (BPI) and Mental Health Inventory-17 (MHI-17), respectively. Electronic medical record review provided cancer-related and demographic information. The presence of physical impairments was determined through a comprehensive musculoskeletal and neurological physical examination including the 6 minute walk test. Linear and ordinal logistic regression models were constructed with function metrics as dependent variables. Results: Total number of physical impairments, BPI scores, and the presence of pleural effusions were highly significant in all models (p<0.01). Exertional intolerance and age were associated with PF-10 and OARS-ADL scores (p<0.01), while the presence of a pre-morbid disability was associated compromised mobility. Conclusions: Potentially remediable factors; pain intensity, cumulative impairment burden and pleural effusions, degrade all functional domains in patients with stage IV breast cancer. No significant financial relationships to disclose.

Effect of palliative surgery, chemotherapy, and radiation in stage IV pancreatic cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15707-e15707 ◽  
Author(s):  
Brooke Vuong ◽  
Ahmed Dehal ◽  
Amanda N Graff-Baker ◽  
Shu-Ching Chang ◽  
Leland Foshag ◽  
...  
Keyword(s):  
Overall Survival ◽  
Palliative Therapy ◽  
Stage Iv ◽  
Multimodality Treatment ◽  
Palliative Surgery ◽  
Cancer Data ◽  
Risk Of Death ◽  
Dismal Prognosis ◽  
Increased Risk ◽  
The Impact

e15707 Background: Despite significant advances in multi-modality treatment for pancreatic adenocarcinoma (PC), prognosis for stage IV PC remains poor. While reducing suffering and optimizing quality of life are the primary goals of palliative therapies, these interventions may extend overall survival. We examined the impact on survival when aggressive palliative treatments including surgery, chemotherapy, or radiation were employed in end-of-life care. Methods: The 2004-2014 National Cancer Data Base (NCDB) was queried to identify patients with stage IV PC that did not undergo primary surgical resection. Univariate (Kaplan Meier and log-rank) and multivariable (Cox proportional hazard) analyses were used to assess the associations between patient characteristics, use of palliative therapies, and overall survival. Results: Of 72,736 patients identified with metastatic stage IV PC, 2,097 (3%) underwent surgical palliation (ST), 5,615 (8%) received palliative chemotherapy (CT), 940 (1%) received palliative radiation (RT), 1,163 (2%) received multimodality treatment (MMT), and 62,921 (87%) had no aggressive palliative intervention (NT). The choice of palliative therapy, if any, was influenced by all demographic and tumor variables except for gender (all p < 0.001). Median OS was greatest after CT (5.09 months, p < 0.001) compared to any other modality (NT: 3.45months, ST: 3.71months, RT: 3.25months, MMT: 4.47months). This remained true regardless of age, gender, race/ethnicity, insurance, and facility type. After adjusting for all demographic and tumor factors, use of CT decreased the annual risk of death by 20% (HR = 0.8; 95%CI [0.77, 0.82]) and MMT by 10% (HR = 0.9; 95%CI [0.84, 0.96]). Employment of RT increased risk of death by 9% (HR = 1.09; 95%CI [1.01, 1.17]) and ST did not affect OS (HR = 1.01; 95%CI [0.96,1.06]). Conclusions: Despite advances in palliative treatments, Stage IV PC arries a dismal prognosis. Palliative RT may shorten survival. Equivalent survival for ST versus NT suggests that this may be beneficial in the appropriate patient. Palliative CT independently improved survival by approximately 6 weeks and should be considered in patients that want to extend survival and can tolerate the toxicity.

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