scholarly journals Endoscopic versus nonendoscopic surgery for resection of pituitary adenomas: a national database study

2020 ◽  
pp. 1-9 ◽  
Author(s):  
Khodayar Goshtasbi ◽  
Brandon M. Lehrich ◽  
Mehdi Abouzari ◽  
Arash Abiri ◽  
Jack Birkenbeuel ◽  
...  
Keyword(s):  
Tumor Size ◽  
Household Income ◽  
Pituitary Adenomas ◽  
Private Insurance ◽  
Large Population ◽  
Treatment Center ◽  
National Database ◽  
Insurance Status ◽  
Treatment Site ◽  
Comorbidity Burden

OBJECTIVEFor symptomatic nonsecreting pituitary adenomas (PAs), resection remains a critical option for treatment. In this study, the authors used a large-population national database to compare endoscopic surgery (ES) to nonendoscopic surgery (NES) for the surgical management of PA.METHODSThe National Cancer Database was queried for all patients diagnosed with histologically confirmed PA who underwent resection between 2010 and 2016 in which the surgical approach was specified. Due to database limitations, microsurgery and craniotomy were both categorized as NES.RESULTSOf 30,488 identified patients, 16,373 (53.7%) underwent ES and 14,115 (46.3%) underwent NES. There was a significant increase in the use of ES over time (OR 1.16, p < 0.01). Furthermore, there was a significant temporal increase in ES approach for tumors ≥ 2 cm (OR 1.17, p < 0.01). Compared to NES, patients who underwent ES were younger (p = 0.01), were treated at academic centers (p < 0.01), lived a greater distance from their treatment site (p < 0.01), had smaller tumors (p < 0.01), had greater medical comorbidity burden (p = 0.04), had private insurance (p < 0.01), and had a higher household income (p < 0.01). After propensity score matching to control for age, tumor size, Charlson/Deyo score, and type of treatment center, patients who underwent ES had a shorter length of hospital stay (LOS) (3.9 ± 4.9 days vs 4.3 ± 5.4 days, p < 0.01), although rates of gross-total resection (GTR; p = 0.34), adjuvant radiotherapy (p = 0.41), and 90-day mortality (p = 0.45) were similar. On multivariate logistic regression, African American race (OR 0.85, p < 0.01) and tumor size ≥ 2 cm (OR 0.89, p = 0.01) were negative predictors of receiving ES, whereas diagnosis in more recent years (OR 1.16, p < 0.01), greater Charlson/Deyo score (OR 1.10, p = 0.01), receiving treatment at an academic institution (OR 1.67, p < 0.01) or at a treatment site ≥ 20 miles away (OR 1.17, p < 0.01), having private insurance (OR 1.09, p = 0.01), and having a higher household income (OR 1.11, p = 0.01) were predictive of receiving ES. Compared to the ES cohort, patients who started with ES and converted to NES (n = 293) had a higher ratio of nonwhite race (p < 0.01), uninsured insurance status (p < 0.01), longer LOS (p < 0.01), and higher rates of GTR (p = 0.04).CONCLUSIONSThere is an increasing trend toward ES for PA resection including its use for larger tumors. Although ES may result in shorter LOS compared to NES, rates of GTR, need for adjuvant therapy, and short-term mortality may be similar. Factors such as tumor size, insurance status, facility type, income, race, and existing comorbidities may predict receiving ES.

Impact of socioeconomic status (SES) on colorectal cancer patient survival: An analysis of 890,867 patients in the National Cancer Database (NCDB).

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 19-19
Author(s):  
Mohamed E. Salem ◽  
Sally Jeanne Trufan ◽  
James Thomas Symanowski ◽  
Kunal C. Kadakia ◽  
Alberto Puccini ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Low Income ◽  
Private Insurance ◽  
Colorectal Cancer Patient ◽  
Insurance Coverage ◽  
Treatment Center ◽  
Insurance Status ◽  
Strong Impact ◽  
Risk Of Death ◽  
Increased Risk

19 Background: SES has been associated with outcomes in cancer patients (pts). We examined associations between SES and survival of pts with colorectal cancers (CRC). Methods: The NCDB was used to examine the association of SES status with clinicopathological features and outcomes of colorectal cancer pts, categorized by the income and education level of their area of residence. Logistic regression, Cox proportional hazard model, and chi-square test were used to examine the differences between groups. Results: A retrospective analysis of 890,867 pts with CRC (right-sided 34.1%, transverse 11.9%, left-sided 46.2%, and rectal 7.8%) diagnosed between 2004 and 2016, was conducted. About half the pts were male (51.4%); 84.3% were white, 11.2% black, and 4.5% of other races. Overall, 30.8% of pts lived in the highest and 18.4% in the lowest income areas. Twenty-three percent lived in areas comprising the highest high school graduation rate areas (>93%), while 17.4% lived in the lowest (< 79%). Compared to pts living in high-income areas, pts living in the lowest income areas were more likely to be black (OR 6.2, 6.1-6.3), present at a younger age (18-30 yrs vs. >70 yrs; OR 1.28, 1.18-1.39), have T3/T4 disease at presentation (OR 1.03, 95%CI 1.02-1.04), left-sided tumors (OR 1.05, 1.04-1.06), higher Charlson-Deyo score (OR 1.34, 1.33-1.36), and have Medicaid (OR: 3.9, 3.8-4.0) or no health insurance (OR: 2.9, 2.8-3.0). Tumor location and grade, stage, age, sex, race, ethnicity, income, education, insurance status, Charlson-Deyo score, and type of treatment center were independent predictors for survival in the multivariate analysis. Pts living in the lowest income and lowest education areas had a 13% and 4% higher risk of death, respectively, compared to pts in the highest income areas and education areas. Black pts had a 7% increased risk of death. Pts with Medicaid and no insurance coverage had a 44% and 29% increased risk of death, respectively, compared to pts with private insurance. Conclusions: CRC pts living in areas of low income and low education had worse survival. Insurance status and type of treatment center also have a strong impact on survival. Sociodemographic characteristics need to be taken into account and studied further, with the aim of improving outcomes for all pts. [Table: see text]

scholarly journals Association of Insurance Types and Survival in Acute Promyelocytic Leukemia (APL)

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4129-4129
Author(s):  
Prajwal Dhakal ◽  
Elizabeth R. Lyden ◽  
Utsav Joshi ◽  
Avantika Pyakuryal ◽  
Krishna Gundabolu ◽  
...  
Keyword(s):  
Research Funding ◽  
Cox Regression ◽  
Private Insurance ◽  
Multiple Logistic Regression Analysis ◽  
Significant Proportion ◽  
The United States ◽  
Treatment Center ◽  
Uninsured Patients ◽  
Younger Patients ◽  
Comorbidity Burden

Abstract Introduction Health insurance, or lack thereof, is a significant barrier to health care access in the United States. Patients without insurance or with inadequate coverage are more likely to delay or forego treatment, even with acute illness or significant symptoms, leading to worse health outcomes. We aimed to analyze if insurance types impacted one-month mortality and overall survival (OS) in younger patients with APL. Methods We utilized National Cancer Database to identify patients &lt;65 years who were diagnosed with APL between 2004-2015. We used multiple logistic regression analysis to evaluate the effects of insurance type on the probability of one-month mortality. OS was estimated by the Kaplan-Meier method. A full Cox regression model was used to determine the effects of insurance types on mortality. Results A total of 5380 patients were included. Median age was 44 years (0-64), 50% were female, 93% had Charlson-Deyo comorbidity index (CCI) of 0 or 1, and 58% were treated at academic centers. Insurance types included private (67%), Medicaid or other government insurance (19%), Medicare (7%) or uninsured (6%). Patients with Medicare were older and had increased comorbidities. Lower percent of patients with Medicare (23%) or Medicaid/Other government insurance (21%), compared to those with private insurance (56%) or uninsured patients (63%) were treated at academic centers. One-month mortality was higher for patients with Medicare (16%) or uninsured patients (14%), compared to those with Medicaid/Other government (8%) or private insurance (7%).Patients with Medicare (Odds ratio [OR] 1.69, 95% confidence interval [CI] 1.23-2.32, p=0.001) or uninsured patients (OR 2.23, 95% CI 1.56-3.18, p&lt;0.0001) had worse one-month mortality compared to those with private insurance (Table 1). One-month mortality worsened with increasing comorbidities (OR 2.31 for CCI 1, OR 4.44 for CCI 2, and OR 7.02 for CCI ≥3 compared to patients with CCI of 0, p&lt;0.0001). Female patients and patients traveling &lt;6 miles to the treatment center had lower one-month mortality. Median follow-up for surviving patients was 5.4 years (0.008-13.9). Three-year OS was 89% for private insurance, 81% for Medicaid/Other government insurance, 63% for Medicare, and 80% for uninsured patients (Table 2, Figure 1). Patients with Medicaid/Other government insurance (hazard ratio [HR] 1.39, 95% CI 1.19-1.63 p&lt;0.0001), and Medicare (HR 1.88, 95% CI 1.57-2.24, p&lt;0.0001) were associated with worse OS compared to patients with private insurance (Table 3). Compared to patients ≤18 years of age, the likelihood of death was worse for patients 41-64 years (HR 0.68, 95% CI 1.47-4.90, p=0.001). OS worsened with increasing comorbidities (HR 1.71 for CCI 1, HR 2.33 for CCI 2, and HR 3.48 for CCI ≥3 compared to patients with CCI of 1, p&lt;0.0001). Male gender (p=0.0002) was associated with decreased OS. Conclusion In one of the largest database analyses, we identified insurance status as a significant factor affecting one-month mortality and OS in APL. Our results revealed a higher one-month mortality but similar longer-term OS in uninsured patients compared to patients with private insurance, which may reflect poor access to healthcare necessary for prompt diagnosis and timely initial treatment; similar longer-term OS may reflect a higher proportion of younger patients with less comorbidities in uninsured group. Patients with Medicaid/Other government or Medicare insurance had worse OS compared to private insurance. The reasons for worse OS may be multifactorial including problems with access to quality leukemia care or drug coverage, or the effects of other differences in the patient population including income and in case of Medicare patients, older age and comorbidity burden. Our results raise concern for healthcare disparities based on insurance types and highlight challenges associated with improving OS in patients with Medicaid, Medicare, or no insurance, which comprise a significant proportion of patients with APL. Figure 1 Figure 1. Disclosures Gundabolu: Samus Therapeutics: Research Funding; Pfizer: Research Funding; BioMarin Pharmaceuticals: Consultancy; Blueprint Medicines: Consultancy; Bristol-Myers Squibb Company: Consultancy. Bhatt: Genentech: Consultancy; Abbvie: Consultancy, Research Funding; National Marrow Donor Program: Research Funding; Tolero Pharmaceuticals, Inc: Research Funding; Pfizer: Research Funding; Incyte: Consultancy, Research Funding; Jazz: Research Funding; Abbvie: Consultancy, Research Funding; Partnership for health analytic research, LLC: Consultancy; Servier Pharmaceuticals LLC: Consultancy; Rigel: Consultancy.

scholarly journals EPIDEMIOLOGY OF PEDIATRIC CARTILAGE RESTORATION PROCEDURES IN THE UNITED STATES: INSURANCE AND GEOGRAPHY PLAY A ROLE

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0024
Author(s):  
Tyler B. Hall ◽  
Max J. Hyman ◽  
Neeraj M. Patel
Keyword(s):  
United States ◽  
Children And Adolescents ◽  
Statistical Significance ◽  
Private Insurance ◽  
Univariate Analysis ◽  
The United States ◽  
National Database ◽  
The West ◽  
Cartilage Restoration ◽  
Common Diagnosis

Background: A number of surgical options are available for sizeable articular cartilage lesions of the knee. These include osteochondral autograft (OAU) or allograft (OAL) transfer, or autologous chondrocyte implantation (ACI). In the pediatric population, there is little data on the patients undergoing these procedures or evidence to support one technique over another, which may lead to variation in preferred practice. Hypothesis/Purpose: The purpose of this study is to analyze the epidemiology of children and adolescents undergoing OAU, OAL, and ACI in the United States, with attention to variation along the lines of demographic and geographic factors. Methods: The Pediatric Health Information System, a national database consisting of 49 children’s hospitals, was queried for all patients undergoing OAU, OAL, and ACI between 2012 and 2018. Demographic information was collected for each subject. United States Census guidelines were used to categorize hospitals geographically into regions. Univariate analysis was followed by purposeful entry multivariate regression to adjust for confounding factors. Results: A total of 809 subjects with a mean age of 15.4±2.4 years were included in the analysis. Of these, 393 (48.6%) underwent OAL, 339 (41.9%) underwent OAU, and 77 (9.5%) underwent ACI. The most common diagnosis at the time of surgery was osteochondritis dissecans in 360 patients (44.5%) followed by an associated cruciate ligament injury in 126 (15.6%) and patellar instability in 98 (12.1%). After adjusting for confounders in a multivariate model, ACI was more 3.4 times more likely to be performed in patients with private insurance than those that were publicly insured (95% CI 1.5-7.5, p=0.002). Furthermore, a patient in this Northeast was 29.3 times more likely to undergo ACI than in the West (95% CI 4.0-217.4, p=0.001). OAU was performed most frequently in the West and Midwest (52.4% and 51.8% of the time, respectively; p<0.001). Univariate analysis also revealed differences along the lines of race, but these findings did not maintain statistical significance in multivariate analysis. Conclusion: In the United States, there is substantial variation in the procedures performed for cartilage restoration in children and adolescents. Though ACI is the least commonly selected operation overall, it is significantly more likely to be performed on patients with private insurance and those in the Northeast. OAU is the most commonly performed procedure in the West and Midwest.

AML-242: Impact of Insurance Status and Distance from Residence to Treatment Center on the Outcomes of Patients Diagnosed with Acute Myeloid Leukemia

2021 ◽  
Vol 21 ◽  
pp. S294
Author(s):  
Layal Al Mahmasani ◽  
Maya Mahmoud ◽  
Maya Charafeddine ◽  
Jean El Cheikh ◽  
Ali Bazarbachi ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Treatment Center ◽  
Insurance Status ◽  
Acute Myeloid

Abstract P076: Increased Burden Of Chronic Illness Among Insured Compared To Uninsured Sudden Death Victims

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Reaves Houston ◽  
Susan Keen ◽  
Chelsea Deitelzweig ◽  
Hannah Jones ◽  
Sarah Laible ◽  
...  
Keyword(s):  
Health Insurance ◽  
Chronic Illness ◽  
Sudden Death ◽  
Private Insurance ◽  
Chronic Illnesses ◽  
Categorical Variables ◽  
Insurance Status ◽  
Public Insurance ◽  
Status Data ◽  
Lower Frequencies

Introduction: Lack of health insurance is associated with reduced access to medical care and increased mortality. Chronic illness is associated with sudden death, a major cause of natural death. Insurance status of sudden death victims has not been characterized. Hypothesis: Uninsured compared to insured sudden death victims will have more chronic illnesses. Methods: From 2013-2015, emergency medical services-attended out of hospital deaths among ages 18-64 in Wake County, NC were screened to adjudicate sudden deaths. Medical records were reviewed for demographic, clinical, and health insurance status data. Insurance status was characterized as private, public, or no insurance. Cases were excluded from the analysis if no information on insurance was available. Comparisons of demographic and clinical characteristics were made between the three insurance status groups using Student’s t-test and ANOVA for continuous and categorical variables, respectively. Results: Of 399 cases of sudden death, insurance status data was available for 130: 25 (19.2%) had no insurance, 62 (47.7%) had public insurance, 31 (23.8%) had private insurance, and 12 (9.2%) had insurance of unknown type. Uninsured victims had lower frequencies of hypertension, hyperlipidemia, and chronic respiratory disease than those with private or public insurance, and lower frequencies of diabetes mellitus, mental illness, and substance abuse than those publicly insured (Table 1). No significant differences were found in coronary artery disease, age, gender, race, marital status, or years of education. Conclusion: Uninsured sudden death victims have less chronic illnesses than those insured. This counterintuitive finding suggests that uninsured sudden death victims have undiagnosed chronic illnesses that are treatable and preventable and contribute to their death. Our results suggest that expanding health insurance among working age adults may reduce the incidence of sudden death.

Abstract 3023: The Association of Insurance Status, Quality of Care, and In-Hospital Outcomes among Patients Hospitalized with Intracerebral Hemorrhage: Findings from GWTG-Stroke

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Michael L James ◽  
Julian P Yand ◽  
Maria Grau-Sepulveda ◽  
DaiWai M Olson ◽  
Deepak L Bhatt ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Length Of Stay ◽  
Intracerebral Hemorrhage ◽  
Reference Group ◽  
Private Insurance ◽  
Quality Measures ◽  
Geographic Region ◽  
Insurance Status ◽  
Hospital Outcomes

Introduction Intracerebral hemorrhage (ICH) can be a devastating condition, requiring intensive intervention. Yet, few studies have examined whether patient insurance status is associated with ICH care or acute outcomes. Methods Using data from 1,711 sites participating in GWTG-Stroke database from April 2003 to April 2011, we identified 156,848 non-transferred subjects with ICH who had known discharge status. Insurance status was categorized as private, Medicaid, Medicare or none. We explored associations between lack of insurance (using private insurance status as the reference group) and in-hospital outcomes (mortality, ambulatory status, & length of stay) and quality of care measures (DVT prophylaxis, smoking cessation, dysphagia screening, stroke education, imaging times, & rehabilitation). We utilized multiple individual (including demographics and medical history) and hospital (including size, geographic region and academic teaching status)lcharacteristics as covariates. Results Subjects without insurance (n=10647) were younger (54.4 v. 71 years), more likely men (60.6 v. 50.8%), more likely black (33.2 v. 17.4%) or Hispanic (15.8 v. 7.9%), from the South (50.6 v. 38.9%), and had fewer vascular risk factors with the exception of smoking when compared with the overall subject population. Further, subjects without insurance were more likely to experience in-hospital mortality (25.9 v. 23.9%; adjusted OR 1.29) and longer length of stay (11.4 v. 7.8 days), but were more likely to receive all quality measures of care, be discharged home (52.1 v. 36.1%), and ambulate independently (47.5 v. 38.5%) at discharge compared with subjects with private insurance (n=40033). Conclusions Among GWTG-Stroke participating hospitals, ICH patients without insurance were more likely to die while in the hospital but experienced higher quality measures of care and were more likely to ambulate independently at discharge should they survive.

Healthcare utilization and outcomes in HIV versus non-HIV patients with hepatocellular cancer: A nationwide analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16189-e16189
Author(s):  
Jennifer C Asotibe ◽  
Ikechukwu Achebe ◽  
Syed Ali Amir Sherazi ◽  
Muhammad-Sheharyar Warraich ◽  
Bashar Attar ◽  
...  
Keyword(s):  
Healthcare Utilization ◽  
Protein Energy Malnutrition ◽  
Hepatocellular Cancer ◽  
Kidney Injury ◽  
Hospital Charges ◽  
Teaching Hospitals ◽  
National Database ◽  
Inpatient Mortality ◽  
Comorbidity Burden ◽  
Secondary Outcomes

e16189 Background: Hepatocellular Carcinoma (HCC) remains a leading cause of cancer related mortality and has a 5-year survival after diagnosis of under 20%. HIV-HCC patients are reported to present with advanced disease and shorter survival compared to non-HIV-HCC patients. HIV has not been known to have a direct causal relationship with HCC but chronic immunosuppression, direct effects of HIV virus on liver parenchyma and use of hepatotoxic antiretroviral medications are thought to contribute to the pathogenesis of HCC (Curr Opin HIV AIDS 2017;12:20-25). We studied differences in outcomes and healthcare utilization between HIV and non-HIV-HCC from a national database. Methods: Healthcare Cost Utilization Project (HCUP) National Inpatient Sample (NIS) database was queried to identify all HIV and non-HIV HCC admissions between 2016-2018. The groups were compared for socio-demographic differences, inpatient mortality, length of stay (LOS) and total hospital charges (THC). Secondary outcomes studied were rates of acute kidney injury (AKI), encephalopathy, anemia, upper GI Bleed (LGIB), tumor lysis (TLS), portal hypertension (PH), sepsis, septic shock (SS), neutropenia and protein energy malnutrition (PEM). Statistics were performed using the t-test, univariate and multivariate logistic regression. Results: A total of 845 HIV-HCC and 88,805 non-HIV-HCC inpatient admissions were identified. Compared to non-HIV-HCC, HIV-HCC patients were significantly younger (mean age 59.3 vs 64.7 years, p < 0.0001) with fewer over 65 years old (21.9 % vs 47.4%, p < 0.0001), more males (87.6% vs 74.3%, p < 0.0002) and African American (AA) (44.8% VS 15.9%, p < 0.0001). HIV-HCC cohort were more likely to be treated at a teaching hospital (89% vs 81%, p < 0.035) and had higher comorbidity burden as defined by a high Charlson comorbidity index (p < 0.01) compared to non-HIV-HCC. Odds of adjusted inpatient mortality (aOR= 0.47, CI = 0.27–0.82, p = 0.007) was significantly lower in HIV-HCC with similar LOS (6.5 vs 6.1 days, p = NS) and THC ($85,930 vs $84,592, p = NS) compared to non-HIV-HCC. While rates of neutropenia (2.96% vs 0.62%, p < 0.001) and PEM (26.0% vs 16.3%, p = 0.01) were higher in HIV-HCC, rates of other secondary outcomes were similar compared to non-HIV cohort. Conclusions: HIV-HCC patients are younger, AA, and men with significantly lower inpatient mortality and similar healthcare utilization compared to non-HIV-HCC, despite higher rates of PEM and neutropenia, possibly reflecting advancements in HIV-HCC treatment, and contributed to by younger age and treatment at teaching hospitals. Further studies are needed to evaluate and assess the effect of co-infection with hepatitis on HIV-HCC outcomes which was not evaluated in present study and investigate interventions aimed to reduce complications like PEM and neutropenia to further improve outcomes.

Relationship between insurance status and diagnosis of cutaneous immune-related adverse events.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18535-e18535
Author(s):  
Michael Chang ◽  
Nira A. Krasnow ◽  
Amy E. Blum ◽  
Vartan Pahalyants ◽  
William S. Murphy ◽  
...  
Keyword(s):  
Linear Regression ◽  
Adverse Events ◽  
Massachusetts General Hospital ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Multivariable Analysis ◽  
Maculopapular Rash ◽  
Insurance Status ◽  
Billing Data ◽  
Delays In Diagnosis

e18535 Background: Cutaneous immune-related adverse events (cirAEs) are among the most common side effects of immune checkpoint inhibitor (ICI) therapy. While insurance status has been shown to influence outcomes in patients treated with ICIs, its impact on cirAE management remains underexplored. We therefore evaluated insurance status in patients with cirAEs, examining its effect on rate of and time to cirAE diagnosis. Methods: Using billing data, we retrospectively identified patients who initiated anti-PD-1/PDL-1 and/or anti-CTLA-4 therapy at Massachusetts General Hospital between January 1, 2016 and March 8, 2019 (n = 2,459) for possible cirAE. Eligible cirAEs included reactions attributed to ICI by the clinician, consistent with established morphologic categories. For each patient with confirmed cirAE (n = 358), we abstracted oncologic history, cirAE features, and insurance status. Associations between insurance and cirAE diagnosis outcomes were assessed via logistic and linear regression, and adjusted for age, sex, race, ICI type, cancer diagnosis, cirAE type, and significant covariates ( P< 0.05). Results: Of the 2,459 patients who received ICIs, 2,419 (98.4%) had documented insurance status. Most ICI recipients had Medicare (n = 1,119; 46.3%) or private insurance (n = 1,156; 47.8%) relative to Medicaid (n = 104; 4.3%) or other government insurance (e.g. Tricare) (n = 40; 1.7%). We found that 358 (median age 64 years, 40.5% female) developed a cirAE. Among cirAE patients, 175 had Medicare (48.9%), 174 had private insurance (48.6%), 6 had Medicaid (1.7%), and 3 had other government insurance (0.8%). The most common cirAEs across insurance types were maculopapular rash, pruritus, and eczematous and lichenoid eruptions. In the multivariable analysis, ICI patients with Medicare insurance had a higher rate of cirAE diagnosis (adjusted odds ratio: 2.41, 95% CI: 1.00, 5.90, P= 0.05) relative to Medicaid patients. In addition, in terms of time to cirAE diagnosis at dermatology visit, Medicare insurance was associated with longer delays, with a linear regression coefficient of 132.2 (95% CI: 4.78, 259.6; P= 0.04). No significant associations were found between other insurance types and cirAE diagnosis outcomes. Conclusions: Our study shows that patients with Medicaid are less likely to be diagnosed with cirAE relative to those with Medicare, despite delays in diagnosis, when controlling for all other demographic/oncologic factors. Ultimately, these findings are reassuring that despite insurance differences, patients with cirAEs are receiving suitable care and appropriately seen by dermatologists. As insurance coverage for specialists can vary widely, these initial findings are a promising indicator that patients with cirAEs are well-connected within healthcare systems.

Clinical and Socioeconomic Factors that Predict Non-completion of Adjuvant Chemotherapy for Colorectal Cancer in a Rural Cancer Center

2022 ◽  
pp. 000313482110547
Author(s):  
Chelsea Knotts ◽  
Alexandra Van Horn ◽  
Krysta Orminski ◽  
Stephanie Thompson ◽  
Jacob Minor ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Socioeconomic Factors ◽  
Cancer Patients ◽  
Private Insurance ◽  
Stage Ii ◽  
Stage Iii ◽  
Insurance Status ◽  
Complete Treatment ◽  
Colorectal Cancer Patients

Background Previous literature demonstrates correlations between comorbidities and failure to complete adjuvant chemotherapy. Frailty and socioeconomic disparities have also been implicated in affecting cancer treatment outcomes. This study examines the effect of demographics, comorbidities, frailty, and socioeconomic status on chemotherapy completion rates in colorectal cancer patients. Methods This was an observational case-control study using retrospective data from Stage II and III colorectal cancer patients offered chemotherapy between January 01, 2013 and January 01, 2018. Data was obtained using the cancer registry, supplemented with chart review. Patients were divided based on treatment completion and compared with respect to comorbidities, age, Eastern Cooperative Oncology Group (ECOG) score, and insurance status using univariate and multivariate analyses. Results 228 patients were identified: 53 Stage II and 175 Stage III. Of these, 24.5% of Stage II and 30.3% of Stage III patients did not complete chemotherapy. Neither ECOG status nor any comorbidity predicted failure to complete treatment. Those failing to complete chemotherapy were older (64.4 vs 60.8 years, P = .043). Additionally, those with public assistance or self-pay were less likely to complete chemotherapy than those with private insurance ( P = .049). Both factors (older age/insurance status) remained significant on multivariate analysis (increasing age at diagnosis: OR 1.03, P =.034; public insurance: OR 1.84, P = .07; and self-pay status: OR 4.49, P = .03). Conclusions No comorbidity was associated with failure to complete therapy, nor was frailty, as assessed by ECOG score. Though frailty was not significant, increasing age was, possibly reflecting negative attitudes toward chemotherapy in older populations. Insurance status also predicted failure to complete treatment, suggesting disparities in access to treatment, affected by socioeconomic factors.

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