Effect of Insurance Status on the Stage of Breast and Colorectal Cancers in a Safety-Net Hospital

In a safety-net hospital, patients with Medicaid have rates of advanced-stage cancer similar to those of patients with other types of insurance; however, patients with no insurance have significantly higher rates of advanced disease.

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Impact of insurance status on overall survival after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC)

Pleura and Peritoneum ◽

10.1515/pp-2020-0105 ◽

2020 ◽

Vol 5 (3) ◽

Author(s):

Ravi J. Chokshi ◽

Jin K. Kim ◽

Jimmy Patel ◽

Joseph B. Oliver ◽

Omar Mahmoud

Keyword(s):

Overall Survival ◽

Neoadjuvant Chemotherapy ◽

Abdominal Wall ◽

Intraperitoneal Chemotherapy ◽

Hyperthermic Intraperitoneal Chemotherapy ◽

Safety Net ◽

Insurance Status ◽

Gynecologic Malignancies ◽

Safety Net Hospital ◽

The Impact

AbstractObjectivesThe impact of insurance status on oncological outcome in patients undergoing cytoreduction and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is poorly understood.MethodsRetrospective study on 31 patients having undergone 36 CRS-HIPEC at a single institution (safety-net hospital) between 2012 and 2018. Patients were categorized as insured or underinsured. Demographics and perioperative events were compared. Primary outcome was overall survival (OS).ResultsA total of 20 patients were underinsured and 11 were insured. There were less gynecologic malignancies in the underinsured (p=0.02). On univariate analysis, factors linked to poor survival included gastrointestinal (p=0.01) and gynecologic malignancies (p=0.046), treatment with neoadjuvant chemotherapy (p=0.03), CC1 (p=0.02), abdominal wall resection (p=0.01) and Clavien–Dindo 3-4 (p=0.01). Treatment with neoadjuvant chemotherapy and abdominal wall resections, but not insurance status, were independently associated with OS (p=0.01, p=0.02 respectively). However, at the end of follow-up, six patients were alive in the insured group vs. zero in the underinsured group.ConclusionsIn this small, exploratory study, there was no statistical difference in OS between insured and underinsured patients after CRS-HIPEC. However, long-term survivors were observed only in the insured group.

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Relationship of emergency department use pre- and post-cancer diagnosis in safety-net adults.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.6626 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 6626-6626

Author(s):

Arthur Hong ◽

Navid Sadeghi ◽

John Vernon Cox ◽

Simon Craddock Lee ◽

Ethan Halm

Keyword(s):

Emergency Department ◽

Cancer Diagnosis ◽

Initial Treatment ◽

Safety Net ◽

Urgent Care ◽

Cancer Type ◽

Advanced Stage ◽

Seeking Behavior ◽

Ed Visits ◽

Advanced Stage Cancer

6626 Background: Safety-net adults generate a high rate of emergency department (ED) visits within the 180 days after a new cancer diagnosis, many of which could be alternatively triaged to an urgent care clinic. It is unclear how much of this ED use is attributable to the cancer and treatment vs. ED-seeking behavior. To identify patients at risk of frequent ED use, we explored whether a patient’s pre-cancer ED visit use predicted ED use after diagnosis. Methods: We identifiably linked adults from the tumor registry in the Dallas County safety-net health system to a regional hospital database with claims-like data for all patients from 98% of non-federal hospitals in North Texas. We applied a mixed-effects multivariate logit model, using frequent ED use (≥4 visits) in the 6-12 months or 12-18 months before diagnosis to predict frequent ED use after diagnosis, adjusting for demographics, comorbidities; cancer type, stage, initial treatment modalities; and grouping visits at the patient level. Results: Of 8,610 adults diagnosed from 2012-2016, 76.2% had Medicaid or were uninsured, 30.9% had lung, breast, or colorectal cancer, and 25.9% had advanced-stage cancer at diagnosis. In the 180 days after diagnosis, 42.5% of patients had zero ED visits, 45.7% had 1-3 visits, and 11.8% were frequent ED users (≥4). In multivariate analysis, patients with frequent ED use in the 6-12 months before a cancer diagnosis had 6.7 higher odds (95% CI: 4.8, 9.3) of having frequent ED use after diagnosis, compared to patients who had zero ED visits prior to diagnosis. This compared to 1.3 higher odds (95% CI: 1.1, 1.5) of frequent ED use if the patient had advanced-stage cancer, and 2.1 higher odds (95% CI: 1.8, 2.4) if chemotherapy was part of initial treatment. Although most post-diagnosis frequent ED users generated zero visits (62.2%) or 1-3 visits (30.7%) in the 6-12 months prior to diagnosis, 38% of patients with frequent ED use pre-diagnosis continued frequent ED visits after diagnosis. Results were similar for ED use 12-18 months prior to diagnosis. Conclusions: Among safety-net adults, prior ED-seeking behavior strongly predicted ED use after a new cancer diagnosis. This may represent a high-risk group that might benefit from care delivery innovation.

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Differences in breast cancer outcomes amongst Black United States-born and Caribbean-born immigrants.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.1088 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 1088-1088

Author(s):

Priscila Barreto Coelho ◽

Danielle Cerbon ◽

Matthew Schlumbrecht ◽

Carlos Parra ◽

Judith Hurley ◽

...

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Safety Net ◽

Cancer Center ◽

Advanced Stage ◽

Cancer Data ◽

Hispanic Caribbean ◽

Safety Net Hospital ◽

The Usa ◽

The Caribbean

1088 Background: The Black population in the US constitutes of 4 million immigrants, with 50% from the Caribbean. It has been shown that breast cancer is responsible for 14%-30% of cancer deaths in the Caribbean; this is up to two times higher than the USA. Methods: Retrospective cohort of 1369 self-identified Black women with breast cancer. Data was obtained from Jackson Memorial Health Systems and University of Miami Health System Tumor Registry. Individual-level data from 1132 cases was used to estimate hazard rations (HRs) of women born in the Caribbean (CB) or in the USA (USB) using Cox proportional hazards regression analysis for overall survival. Median follow-up was 115 months (interquartile range, 91.9-138.1 months) per participant. Results: Data from 622 (54.9%) USB women and 507 (45%) CB women diagnosed with breast cancer between 2006-2017. 90% (n = 1232) of the cohort is of non-Hispanic ethnicity. Caribbean immigrants from Haiti (18.3%), Jamaica (6.5%), Bahamas (3.1%), Cuba and Dominica Republic (2.8% each), Trinidad and Tobago (1%) and other nationalities from the Organization of Eastern Caribbean States were included, mean age 55.7 [95% CI, 54.7-56.8]; USB mean age 57.6 [95% CI, 56.4-58.7] (P = 0.02). Compared to USB, CB had lower BMI at diagnosis 29.6 [95% CI, 28.9-30.3] versus 30.9 [95% CI, 30.1-31.7, P = 0.015]. Compared to CB patients, USB patients had more ER- [31.4% vs 39.1 %, P = 0.018] and triple negative breast cancers [19.6% vs 27.9%, P = 0.003]. Compared to USB patients, CB presented at more advanced stage, III and IV [44.2% vs 35.2%], p = 0.016. In spite of higher advanced stage at diagnoses, CB patients had a better breast cancer overall survival [HR = 0.75; 95%CI, 0.59-0.96; P = 0.024]. Black Hispanic patients had a better overall survival [HR = 0.51; 95%CI, 0.28-0.93; p = 0.028] compared to non-Hispanic Blacks. Compared to Hispanic Caribbean, non-Hispanic Caribbean had a worse overall survival [HR = 1.98; 95%CI, 1.00-3.94; P = 0.048]. The distribution of patients treated at the private cancer center and the safety net hospital were the same, differences in outcomes observed are due to intrinsic differences. Conclusions: This is the largest analysis to date of self-identified Black breast cancer patients in the context of nativity, race, ethnic identity and overall survival with clinico-pathologic characteristics. CB immigrants diagnosed with breast cancer have a better overall survival than US born Black patients. This finding suggests that within the African diaspora in the USA, additional factors beyond race contribute to the outcomes.

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A Low-Literacy Medication Education Tool for Safety-Net Hospital Patients

American Journal of Preventive Medicine ◽

10.1016/j.amepre.2009.08.018 ◽

2009 ◽

Vol 37 (6) ◽

pp. S209-S216 ◽

Cited By ~ 34

Author(s):

Kristina M. Cordasco ◽

Steven M. Asch ◽

Doug S. Bell ◽

Jeffrey J. Guterman ◽

Sandra Gross-Schulman ◽

...

Keyword(s):

Safety Net ◽

Low Literacy ◽

Safety Net Hospital ◽

Hospital Patients ◽

Education Tool

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African Americans with Hepatocellular Carcinoma Have Significantly More Advanced Disease at Presentation: A Safety-Net Hospital Experience

The American Journal of Gastroenterology ◽

10.14309/00000434-201610001-00759 ◽

2016 ◽

Vol 111 ◽

pp. S342

Author(s):

Jonathan Chan ◽

Taft Bhuket ◽

Benny Liu ◽

Robert Wong

Keyword(s):

Hepatocellular Carcinoma ◽

African Americans ◽

Advanced Disease ◽

Safety Net ◽

Hospital Experience ◽

Safety Net Hospital

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Impact of Race, Insurance Status, and Primary Language on Presentation, Treatment, and Outcomes of Patients with Pancreatic Adenocarcinoma at a Safety-Net Hospital

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2019.05.027 ◽

2019 ◽

Vol 229 (4) ◽

pp. 389-396 ◽

Cited By ~ 4

Author(s):

Praveen Sridhar ◽

Priya Misir ◽

Hyunjee Kwak ◽

Susanna WL. deGeus ◽

Frederick T. Drake ◽

...

Keyword(s):

Pancreatic Adenocarcinoma ◽

Safety Net ◽

Insurance Status ◽

Primary Language ◽

Safety Net Hospital

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The influence of perceived neighborhood disorder on smoking cessation among urban safety net hospital patients

Drug and Alcohol Dependence ◽

10.1016/j.drugalcdep.2015.09.004 ◽

2015 ◽

Vol 156 ◽

pp. 157-161 ◽

Cited By ~ 8

Author(s):

Ping Ma ◽

Michael S. Businelle ◽

David S. Balis ◽

Darla E. Kendzor

Keyword(s):

Smoking Cessation ◽

Safety Net ◽

Neighborhood Disorder ◽

Safety Net Hospital ◽

Hospital Patients ◽

Urban Safety

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

10.21203/rs.3.rs-813168/v1 ◽

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.

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