scholarly journals Clinical Benefits Associated With Medicaid Coverage Before Diagnosis of Gynecologic Cancers

2016 ◽  
Vol 12 (6) ◽  
pp. e724-e733 ◽  
Author(s):  
Kemi M. Doll ◽  
Ethan M. Basch ◽  
Ke Meng ◽  
Emma L. Barber ◽  
Paola A. Gehrig ◽  
...  
Keyword(s):  
North Carolina ◽  
Cancer Diagnosis ◽  
Gynecologic Cancer ◽  
Hazard Ratio ◽  
Survival Outcomes ◽  
Advanced Stage ◽  
Stage At Diagnosis ◽  
Medicaid Coverage ◽  
Screening Programs ◽  
Medicaid Enrollment

Purpose: Many low-income patients enroll in Medicaid at the time of cancer diagnosis, which improves survival outcomes. Medicaid enrollment before cancer diagnosis may confer additional benefits. Our objective was to compare stage at diagnosis and overall mortality between women with and without Medicaid enrollment before gynecologic cancer diagnosis. Methods and Materials: Women younger than 65 years with a gynecologic cancer (2003 to 2008) were identified through the North Carolina Central Cancer Registry and linked to state Medicaid enrollment files. Those with and without Medicaid enrollment within 6 months before diagnosis were identified. Propensity matching was used to balance the exposure groups. Stage at diagnosis was evaluated by using logistic regression, and all-cause mortality was assessed with Cox proportional hazard models. Results: Of 564 women, one half (n = 282) had prediagnosis Medicaid enrollment. Disease sites included the cervix (44%), uterus (25%), ovary (26%), and vulva/vagina (5%). More than one half (51%) of cancers were advanced stage. Women without prediagnosis Medicaid had an increased odds of advanced-stage disease (hazard ratio, 1.46; 95% CI, 1.03 to 2.05). Crude survival outcomes differed significantly between the groups; however, when adjusted for stage at diagnosis, lack of prediagnosis Medicaid coverage had a hazard ratio of 1.19 (95% CI, 0.92 to 1.53). Conclusion: Medicaid enrollment before gynecologic cancer diagnosis is associated with an earlier stage at presentation. Given the existence of a cervical cancer screening program in North Carolina and lack of Medicaid expansion, these data suggest that screening programs alone are not sufficient to counteract the delay in diagnosis that is common for uninsured individuals.

scholarly journals Novel Indications of Epigenetic Therapy in Ovarian Cancer

2021 ◽  
Author(s):  
Courtney Griffiths ◽  
Michelle Bilbao ◽  
Lauren Krill ◽  
Olga Ostrovsky
Keyword(s):  
Gene Expression ◽  
Ovarian Cancer ◽  
Early Diagnosis ◽  
Gynecologic Cancer ◽  
Epigenetic Modifications ◽  
Epigenetic Therapy ◽  
Intratumor Heterogeneity ◽  
Survival Outcomes ◽  
Advanced Stage ◽  
Stage Disease

Early diagnosis and intervention are some of the longstanding challenges associated with ovarian cancer, which is the leading cause of gynecologic cancer mortality. While the majority of patients who present with advanced stage disease at time of diagnosis will initially respond to traditional combination platinum and taxane-based chemotherapy in conjunction with cytoreductive surgery, approximately 70% will ultimately recur due to chemoresistance within the first two years. Intratumor heterogeneity is proposed to be a leading factor in the development of chemoresistance and resultant poorer outcomes for those with recurrent or advanced stage disease. Both inherent and acquired mechanisms of chemoresistance are postulated to be a result of alterations in gene expression, also known as epigenetic modifications. Therefore, epigenetic therapy is a pivotal avenue which allows for reversal of chemoresistance in cancer through the targeting of aberrant mutations. In this chapter, we discuss how these epigenetic modifications prove to be promising targets in cancer therapy leading to heightened drug sensitivity and improved patient survival outcomes.

Gynecologic cancer outcomes of Medicare's elderly poor: A population-based study of North Carolina.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 290-290
Author(s):  
Kemi Morenikeji Doll ◽  
Ke Meng ◽  
Ethan M Basch ◽  
Paola A. Gehrig ◽  
Wendy R. Brewster ◽  
...  
Keyword(s):  
North Carolina ◽  
Early Stage ◽  
Uterine Cancer ◽  
Gynecologic Cancer ◽  
Population Based ◽  
Cancer Site ◽  
Advanced Stage ◽  
Survival Curves ◽  
Gynecologic Cancers ◽  
Early Stage Disease

290 Background: Women ≥ 65 years dually enrolled in Medicare and Medicaid (‘Duals’) represent an at-risk group in cancer care, yet their outcomes across the spectrum of gynecologic cancers have not been studied. Our goal was to compare the association of insurance type to stage at diagnosis and mortality of older women after a gynecologic cancer diagnosis. Methods: Population-based, retrospective cohort study of women ≥ 65 years, diagnosed with gynecologic cancers from 2003 – 2009 in North Carolina Central Cancer Registry files. Medicare, Medicaid, and claims from privately insured health plans were linked with census data. Multiple logistic regression, Cox proportional hazard models, and Kaplan Meier survival curves were constructed comparing Medicare, Medicare HMO, and Medicare/Medicaid populations. Results: Among 4,554 patients in the cohort, 3,403 (74%) Medicare+/- supplemental private, 531(11%) Medicare HMO, and 620 (14%) Medicare + Medicaid (Dual). There were 2,215(49%) cases of early stage disease and 1,447(32%) deaths. Dual enrollees had increased mortality rates vs. Medicare overall (HR 1.61, 95%CI:1.4–1.8), and within each cancer site: uterine HR 1.50 (95%CI:1.2-1.9); ovarian HR 1.46 (95%CI:1.1-1.9); cervical HR 1.54 (95%CI:1.0–2.3); and vulvar/vaginal HR 2.84 (95%CI:1.9–4.2). Duals also had increased odds of advanced stage diagnosis in uterine cancer (OR 1.48, 95%CI:1.1–2.0). Stratified survival curves demonstrate the largest disparities amongst women with early stage uterine, advanced stage ovarian, and early stage vulvar/vaginal cancers. Conclusions: Dually enrolled gynecologic cancer patients have a 60% increased mortality rate compared to non-duals despite equivalent stage distribution at the time of diagnosis. Specific site/stage subgroups drive these results and should be the focus of future studies elucidating mediators of these disparate outcomes, including barriers in access to specialty surgical care.

Stage at diagnosis and survival in patients with cancer and a pre-existing mental illness: a meta-analysis

2019 ◽  
Vol 74 (1) ◽  
pp. 84-94 ◽  
Author(s):  
Laura E Davis ◽  
Emma Bogner ◽  
Natalie G Coburn ◽  
Timothy P Hanna ◽  
Paul Kurdyak ◽  
...  
Keyword(s):  
At Risk ◽  
Mental Illness ◽  
Cancer Diagnosis ◽  
Cancer Survival ◽  
Meta Analysis ◽  
Significant Heterogeneity ◽  
Advanced Stage ◽  
Stage At Diagnosis ◽  
High Quality Research ◽  
Causal Pathway

IntroductionIndividuals with a pre-existing mental illness, especially those experiencing reduced social, occupational and functional capacity, are at risk for cancer care disparities. However, uncertainty surrounding the effect of a mental illness on cancer outcomes exists.MethodsWe conducted a systematic review and meta-analysis of observational studies using MEDLINE and PubMed from 1 January 2005 to 1 November 2018. Two reviewers evaluated citations for inclusion. Advanced stage was defined as regional, metastatic or according to a classification system. Cancer survival was defined as time survived from cancer diagnosis. Pooled ORs and HRs were presented. The Newcastle-Ottawa bias risk assessment scale was used. Random-effects models used the Mantel-Haenszel approach and the generic inverse variance method. Heterogeneity assessment was performed using I2.Results2381 citations were identified; 28 studies were included and 24 contributed to the meta-analysis. Many demonstrated methodological flaws, limiting interpretation and contributing to significant heterogeneity. Data source selection, definitions of a mental illness, outcomes and their measurement, and overadjustment for causal pathway variables influenced effect sizes. Pooled analyses suggested individuals with a pre-existing mental disorder have a higher odds of advanced stage cancer at diagnosis and are at risk of worse cancer survival. Individuals with more severe mental illness, such as schizophrenia, are at a greater risk for cancer disparities.DiscussionThis review identified critical gaps in research investigating cancer stage at diagnosis and survival for individuals with pre-existing mental illness. High-quality research is necessary to support quality improvement for the care of psychiatric patients and their families during and following a cancer diagnosis.

From Bench to Bedside: New Technologies for Cancer Diagnosis and Treatment

2008 ◽  
Vol 5 (2) ◽  
Author(s):  
Michal-Ruth Schweiger ◽  
Hans Lehrach
Keyword(s):  
Cancer Diagnosis ◽  
New Technologies ◽  
Early Stage ◽  
Predictive Biomarkers ◽  
Patient Treatment ◽  
Malignant Neoplasms ◽  
Advanced Stage ◽  
Common Cause ◽  
The Us ◽  
Risk Patients

According to the centre for disease control (CDC) malignant neoplasms are the second most common cause of death in the US in 2004 (1). One of the major problems is that most of the cancers are diagnosed in an advanced stage, which prohibits curative treatment. In order to circumvent these problems, we need to develop strategies that allow identification of risk patients and tumors at an early stage. In addition, it is necessary to identify prognostic and predictive biomarkers that guide patient treatment at different stages of the disease.

Techniques' Comparison and Report of the North Carolina Experience

PEDIATRICS ◽  
1989 ◽  
Vol 83 (5) ◽  
pp. 843-848
Author(s):  
Thomas R. Kinney ◽  
Martha Sawtschenko ◽  
Mary Whorton ◽  
Jean Shearin ◽  
Christy Stine ◽  
...  
Keyword(s):  
North Carolina ◽  
Filter Paper ◽  
Screening Program ◽  
Medical Center ◽  
Sample Collection ◽  
Capillary Tubes ◽  
Blood Samples ◽  
Screening Programs ◽  
The North ◽  
Duke University

Controversy still exists as to the best laboratory method to use to screen newborns for sickle cell disease and other hemoglobinopathies. The proposed methods include hemoglobin electrophoresis, column chromatography, isoelectric focusing, and high performance liquid chromatography. There is also debate concerning the preferred method of sample collection. The proposed methods of sample collection include cord blood or blood obtained from the infant collected in a tube with anticoagulant or on filter paper. We compared hemoglobin electrophoresis patterns from infant blood samples collected in heparinized capillary tubes and on filter paper. This comparison was performed because hemoglobin electrophoresis of dried blood samples collected on filter paper has been advocated as a practical, reliable, and inexpensive method for mass screening programs, although the limitations of this technique have not been explored fully. We also summarize data from the North Carolina Newborn Hemoglobinopathy Screening Program, which relates to the advantages and limitations of hemoglobin electrophoresis from filter paper blood specimens. MATERIALS AND METHODS Specimens Four sets of specimens were used for this study: (1) specimens collected at Duke University Medical Center to compare hemoglobin electrophoresis patterns of hemolysates from filter paper and heparinized capillary tubes, (2) specimens collected by the North Carolina program for hemoglobinopathy screening, (3) specimens routinely collected at Duke University in heparinized capillary tubes for newborn hemoglobinopathy screening, and (4) samples for retesting to examine the error rate of the state program and to confirm screening results compatible with a hemoglobinopathy. Samples for Direct Comparison Between Filter Paper and Heparinized Specimens

Association Of Unemployment With Medicaid Enrollment By Social Vulnerability In North Carolina During COVID-19

2021 ◽  
Vol 40 (9) ◽  
pp. 1491-1500
Author(s):  
Paul R. Shafer ◽  
David M. Anderson ◽  
Rebecca Whitaker ◽  
Charlene A. Wong ◽  
Brad Wright
Keyword(s):  
North Carolina ◽  
Social Vulnerability ◽  
Medicaid Enrollment

Association between Performance in a Maintenance of Certification Program and Disciplinary Actions against the Medical Licenses of Anesthesiologists

2018 ◽  
Vol 129 (4) ◽  
pp. 812-820 ◽  
Author(s):  
Yan Zhou ◽  
Huaping Sun ◽  
Alex Macario ◽  
Mark T. Keegan ◽  
Andrew J. Patterson ◽  
...  
Keyword(s):  
North Carolina ◽  
Lower Incidence ◽  
Cumulative Incidence ◽  
Hazard Ratio ◽  
Certification Program ◽  
Disciplinary Actions ◽  
Maintenance Of Certification ◽  
Lower Likelihood ◽  
Significant Change ◽  
Certification Requirements

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background In 2000, the American Board of Anesthesiology (Raleigh, North Carolina) began issuing time-limited certificates requiring renewal every 10 yr through a maintenance of certification program. This study investigated the association between performance in this program and disciplinary actions against medical licenses. Methods The incidence of postcertification prejudicial license actions was compared (1) between anesthesiologists certified between 1994 and 1999 (non–time-limited certificates not requiring maintenance of certification) and those certified between 2000 and 2005 (time-limited certificates requiring maintenance of certification); (2) within the non–time-limited cohort, between those who did and did not voluntarily participate in maintenance of certification; and (3) within the time-limited cohort, between those who did and did not complete maintenance of certification requirements within 10 yr. Results The cumulative incidence of license actions was 3.8% (587 of 15,486). The incidence did not significantly differ after time-limited certificates were introduced (hazard ratio = 1.15; 95% CI, 0.95 to 1.39; for non–time-limited cohort compared with time-limited cohort). In the non–time-limited cohort, 10% (n = 953) voluntarily participated in maintenance of certification. Maintenance of certification participation was associated with a lower incidence of license actions (hazard ratio = 0.60; 95% CI, 0.38 to 0.94). In the time-limited cohort, 90% (n = 5,329) completed maintenance of certification requirements within 10 yr of certificate issuance. Not completing maintenance of certification requirements (n = 588) was associated with a higher incidence of license actions (hazard ratio = 4.61; 95% CI, 3.27 to 6.51). Conclusions These findings suggest that meeting maintenance of certification requirements is associated with a lower likelihood of being disciplined by a state licensing agency. The introduction of time-limited certificates in 2000 was not associated with a significant change in the rate of license actions.

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