Affordable Care Act and Disparities in Health Services Utilization among Ethnic Minority Breast Cancer Survivors: Evidence from Longitudinal Medical Expenditure Panel Surveys 2008–2015

Breast cancer is the most prevalent female cancer in the US. Incidence rates are similar for white and black women but mortality rates are higher for black women. This study draws on rich, nationally representative data, the 2008–2015 Medical Expenditure Panel Surveys, to estimate effects of the Affordable Care Act (ACA) on reducing disparities in and access to use of diagnostic and medical services for black and Hispanic breast cancer survivors. Random effects multinomial logit, flexible hurdle and Box-Cox estimation techniques are used. The robust estimates indicate that the ACA narrowed the racial/ethnic disparity in health insurance coverage, health care utilization and out-of-pocket prescription drug expenditures among breast cancer survivors. Gaps in uninsurance significantly declined for black and Hispanic survivors. Hispanic women generally and black breast cancer survivors specifically increased use of mammography services post-ACA. The ACA did not significantly impact disparities in physician utilization or out-of-pocket prescription drug expenditures for Hispanic survivors, while there were substantive improvements for black breast cancer survivors. The paper concludes with a discussion of the strengths and limitations of the ACA for reducing disparities and improving health outcomes for a growing population of breast cancer survivors in the US.

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Article Commentary: A Research Agenda for Appearance Changes Due to Breast Cancer Treatment

Breast Cancer Basic and Clinical Research ◽

10.4137/bcbcr.s784 ◽

2008 ◽

Vol 2 ◽

pp. BCBCR.S784 ◽

Cited By ~ 3

Author(s):

Mugdha Dabeer ◽

Michelle Cororve Fingeret ◽

Fatima Merchant ◽

Gregory P. Reece ◽

Elisabeth K. Beahm ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Treatment Options ◽

Breast Cancer Treatment ◽

Cancer Treatments ◽

Detection Techniques ◽

The Us ◽

Women’S Perceptions

Breast cancer is one of the most prevalent forms of cancer in the US. It is estimated that more than 180,000 American women will be diagnosed with invasive breast cancer in 2008. Fortunately, the survival rate is relatively high and continually increasing due to improved detection techniques and treatment methods. However, maintaining quality of life is a factor often under emphasized for breast cancer survivors. Breast cancer treatments are invasive and can lead to deformation of the breast. Breast reconstruction is important for restoring the survivor's appearance. However, more work is needed to develop technologies for quantifying surgical outcomes and understanding women's perceptions of changes in their appearance. A method for objectively measuring breast anatomy is needed in order to help both the breast cancer survivors and their surgeons take expected changes to the survivor's appearance into account when considering various treatment options. In the future, augmented reality tools could help surgeons reconstruct a survivor's breasts to match her preferences as much as possible.

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The psychosocial determinants of quality of life in breast cancer survivors: a scoping review

BMC Cancer ◽

10.1186/s12885-020-07389-w ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Michael G. Culbertson ◽

Kathleen Bennett ◽

Catherine M. Kelly ◽

Linda Sharp ◽

Caitriona Cahir

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Social Support ◽

Cancer Survivors ◽

Scoping Review ◽

Breast Cancer Survivors ◽

Psychosocial Determinants ◽

Psychosocial Determinant ◽

The Us

Abstract Background Breast cancer care today involves state-of-the-art biomedical treatment but can fail to address the broader psychosocial and quality-of-life (QoL) issues associated with the transition to breast cancer survivorship. This scoping review examines the evidence on the influence of psychosocial determinants on QoL in breast cancer survivors. Methods Scoping review methodology was used to: (1) identify the research question(s); (2) identify relevant studies; (3) undertake study selection; (4) extract data; (5) collate, summarise and report the results. Results A total of 33 studies met the inclusion criteria. The majority of studies were conducted in the US (n = 22, 67%) and were mainly cross-sectional (n = 26, 79%). Sixteen psychosocial determinants of QoL were identified. Social support (n = 14, 42%), depression (n = 7, 21%) and future appraisal and perspective (n = 7, 21%) were the most frequently investigated determinants. Twelve different QoL measures were used. A range of different measurement tools were also used per psychosocial determinant (weighted average = 6). The 14 studies that measured the influence of social support on QoL employed 10 different measures of social support and 7 different measures of QoL. In general, across all 33 studies, a higher level of a positive influence and a lower level of a negative influence of a psychosocial determinant was associated with a better QoL e.g. higher social support and lower levels of depression were associated with a higher/better QoL. For some determinants such as spirituality and coping skills the influence on QoL varied, but these determinants were less commonly investigated. Conclusion Consensus around measures of QoL and psychological determinants would be valuable and would enable research to determine the influence of psychosocial determinants on QoL adequately. Research in other healthcare settings beyond the US is required, in order to understand the influence of organisation and follow-up clinical and supportive care on psychosocial determinants and QoL and to improve the quality of care in breast cancer survivors.

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Association of Health-Related Quality of Life with Breast Cancer Survival among Hispanic Population Using 10 Years of MEPS National Sample Cohort Data

Clinical Oncology and Research ◽

10.31487/j.cor.2020.08.08 ◽

2020 ◽

pp. 1-9

Author(s):

Jongwha Chang ◽

Marie Angayen ◽

Jihaeng Heo ◽

Susana Lopez ◽

Jongwha Chang

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Cancer Survival ◽

Breast Cancer Survival ◽

Hispanic Population ◽

The Us ◽

Related Quality ◽

Health Related

Background: Breast cancer is the most commonly diagnosed cancer among women in the United States and it is the leading cause of death among the Hispanic population. Little evidence exists the association of health-related quality of life (HRQoL) by the presence of breast cancer survival among the Latina population. This study was to look at the association of the presence of breast cancer survival on HRQoL measure in the US Hispanic population. Methods: This was a cross-sectional study analyzing data from the 2006-2015 Medical Expenditure Panel Survey (MEPS). The target population was comprised of Hispanic community-dwelling residents with breast cancer in the US. Two multivariate regression models were used to predict HRQoL measure by the presence of breast cancer survival among the Hispanic population. Results: A total 207 breast cancer survivors met the study inclusion criteria, and the estimated population size was 1.200,337 breast cancer survivors. In the multiple regression analysis on the SF-12 PCS scores, age, census region, poverty level, perceived health status, BMI, and employment were associated with SF12 PCS scores. The multiple regression analysis on the SF-12 MCS scores presented that age, census region, insurance type, perceived mental health status, and CCI were associated with SF-12 MCS scores. Conclusion: This study presents data on the HRQoL of Hispanic breast cancer survivors in the U.S. It builds on previous research that examines the HRQoL as expressed through the SF-12 PCS and SF-12 MCS surveys, rather than other types of measurement. This study may also be used as a guide in the implementation of clinical interventions and plans for survivorship care in improving the HRQoL of Hispanic breast cancer survivors.

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Genetic Testing and Surveillance of Young Breast Cancer Survivors and Blood Relatives: A Cluster Randomized Trial

Cancers ◽

10.3390/cancers12092526 ◽

2020 ◽

Vol 12 (9) ◽

pp. 2526

Author(s):

Maria C. Katapodi ◽

Chang Ming ◽

Laurel L. Northouse ◽

Sonia A. Duffy ◽

Debra Duquette ◽

...

Keyword(s):

Breast Cancer ◽

Genetic Testing ◽

Black Women ◽

Cancer Survivors ◽

Randomized Trial ◽

Self Efficacy ◽

Breast Cancer Survivors ◽

Cluster Randomized Trial ◽

Cluster Randomized ◽

Young Breast Cancer

We compared a tailored and a targeted intervention designed to increase genetic testing, clinical breast exam (CBE), and mammography in young breast cancer survivors (YBCS) (diagnosed <45 years old) and their blood relatives. A two-arm cluster randomized trial recruited a random sample of YBCS from the Michigan cancer registry and up to two of their blood relatives. Participants were stratified according to race and randomly assigned as family units to the tailored (n = 637) or the targeted (n = 595) intervention. Approximately 40% of participants were Black. Based on intention-to-treat analyses, YBCS in the tailored arm reported higher self-efficacy for genetic services (p = 0.0205) at 8-months follow-up. Genetic testing increased approximately 5% for YBCS in the tailored and the targeted arm (p ≤ 0.001; p < 0.001) and for Black and White/Other YBCS (p < 0.001; p < 0.001). CBEs and mammograms increased significantly in both arms, 5% for YBCS and 10% for relatives and were similar for Blacks and White/Others. YBCS and relatives needing less support from providers reported significantly higher self-efficacy and intention for genetic testing and surveillance. Black participants reported significantly higher satisfaction and acceptability. Effects of these two low-resource interventions were comparable to previous studies. Materials are suitable for Black women at risk for hereditary breast/ovarian cancer (HBOC).

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