scholarly journals Impact of race, poverty, insurance coverage, and resources availability on breast cancer across geographic regions of Mississippi

1939 ◽  
Vol 62 (4) ◽  
pp. 353-369 ◽  
Author(s):  
Hilda Smith ◽  
◽  
Samantha Seal ◽  
Donna Sullivan
Keyword(s):  
Breast Cancer ◽  
Insurance Coverage ◽  
Geographic Regions

Did Medicaid Expansion Mitigate Disparities in Post-mastectomy Reconstruction Rates?

2022 ◽  
pp. 000313482110604
Author(s):  
Alison R. Goldenberg ◽  
Lauren M. Willcox ◽  
Daria M. Abolghasemi ◽  
Renjian Jiang ◽  
Zheng Z. Wei ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Insurance Coverage ◽  
Complex Problem ◽  
Cancer Disparities ◽  
Multivariate Model ◽  
Medicaid Expansion ◽  
The Us ◽  
Caucasian Women ◽  
Breast Cancer Disparities ◽  
To Receive

Background Patient and socioeconomic factors both contribute to disparities in post-mastectomy reconstruction (PMR) rates. We sought to explore PMR patterns across the US and to determine if PMR rates were associated with Medicaid expansion. Methods The NCDB was used to identify women who underwent PMR between 2004-2016. The data was stratified by race, state Medicaid expansion status, and region. A multivariate model was fit to determine the association between Medicaid expansion and receipt of PMR. Results In comparison to Caucasian women receiving PMR in Medicaid expansion states, African American (AA) women in Medicaid expansion states were less likely to receive PMR (OR .96 [.92-1.00] P < .001). Patients in the Northeast (NE) had better PMR rates vs any other region in the US, for both Caucasian and AA women (Caucasian NE ref, Caucasian-South .80 [.77-.83] vs AA NE 1.11 [1.04-1.19], AA-South (.60 [.58-.63], P < .001). Interestingly, AA patients residing in the NE had the highest receipt of PMR 1.11 (1.04-1.19), even higher than their Caucasian counterparts residing in the same region (ref). Rural AA women had the lowest rates of PMR vs rural Caucasian women (.40 [.28-.58] vs .79 [.73-.85], P < .001]. Discussion Racial disparities in PMR rates persisted despite Medicaid expansion. When stratified by region, however, AA patients in the NE had higher rates of PMR than AA women in other regions. The largest disparities were seen in AA women in the rural US. Breast cancer disparities continue to be a complex problem that was not entirely mitigated by improved insurance coverage.

scholarly journals Breast cancer in Portugal: Temporal trends and age-specific incidence by geographic regions

2018 ◽  
Vol 54 ◽  
pp. 12-18 ◽  
Author(s):  
Gonçalo Forjaz de Lacerda ◽  
Scott P. Kelly ◽  
Joana Bastos ◽  
Clara Castro ◽  
Alexandra Mayer ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Temporal Trends ◽  
Geographic Regions

Abstract 4184: Tumor and risk factor characteristics among breast cancer patients from different geographic regions in Peru

2019 ◽  
Author(s):  
Valentina Zavala ◽  
Tatiana Vidaurre ◽  
Katie Marker ◽  
Jeannie Vásquez ◽  
L Tamayo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factor ◽  
Cancer Patients ◽  
Breast Cancer Patients ◽  
Geographic Regions

scholarly journals Adherence to post-surgery follow-up assessment and its association with sociodemographic and disease characteristics in patients with breast cancer in Central China

BMC Cancer ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Ran Feng ◽  
Jingfeng Jing ◽  
Xiaojun Zhang ◽  
Ming Li ◽  
Jinnan Gao
Keyword(s):  
Breast Cancer ◽  
Breast Cancer Survivors ◽  
Insurance Coverage ◽  
Central China ◽  
Axillary Lymph ◽  
Current Guideline ◽  
Curative Surgery ◽  
Post Surgery ◽  
Treatment Characteristics

Abstract Background Follow-up after curative surgery is increasingly recognized as an important component of breast cancer care. Although current guideline regulates the follow-ups, there are no relevant studies on the adherence to it in China. This study investigated the post-surgery follow-up and explored its association with patients, tumor and treatment characteristics. Methods A total of 711 patients underwent surgical treatment in Shanxi Bethune Hospital from March 2012 to May 2018 were included in this study. Baseline sociodemographic, tumor, and treatment characteristics were obtained from the hospital electronic medical records. The post-surgery follow-up was reviewed and assessed from the patient’s follow-up examination record. Factors associated with the first three-year follow up was evaluated using logistic regression analysis. Results The annual follow-up rate after surgery decreased gradually from 67.1% at the 1st year, 60.2% at the 3rd year to 51.9% at the 4th year, and 43.5% at the 5th year. Loss of follow-up during the first 3 years after surgery was significantly associated with older age (> 65 years), lower medical insurance coverage, axillary lymph node dissection, and less intensity of systemic treatment. Conclusion A significant downtrend of annual follow-up rate for breast cancer survivors was confirmed in this study. Loss of follow-up within the first 3 years after surgery was associated with both patient’s characteristics and treatment. These results will provide evidence to help clinicians to develop tailored patient management after curative surgery.

Pain severity and impairment of activity between pegfilgrastim (P) and fixed-dose filgrastim (F) in women with early-stage breast cancer receiving chemotherapy.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19570-e19570
Author(s):  
Mova Leung ◽  
Joy Eustaquio ◽  
Jessica Kano ◽  
Tiffany Marr ◽  
Brian Patrick Higgins ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Joint Pain ◽  
Early Stage ◽  
Insurance Coverage ◽  
Pain Severity ◽  
Daily Activities ◽  
Baseline Risk ◽  
Fixed Dose ◽  
Pain Diary ◽  
Severe Impairment

e19570 Background: In comparative trials of P and F, bone and joint pain are evident and with similar incidences. Also, muscle pain is clinically noted. Pain severity may differ between P and F, especially when a short fixed-dose regimen of F is used. Methods: This is a prospective observational and ethics-approved study. It compares the incidence & severity of muscle and/or joint pain (MJP) in patients (pts) receiving P (6mg SC for 1 day) or fixed-dose F (300mcg SC for 7-8 days) initiated 24 hours after chemotherapy. Eligible were women with breast cancer receiving neo- or adjuvant chemotherapy, and P or F. Choice of P or F were at the oncologist’s discretion based on patient preference & insurance coverage. Pts were ineligible if they could not complete the pain diary, or had received P or F in the past 6 months. Efficacy of P and F was evaluated by comparing febrile neutropenia (FN) and neutropenia (N) requiring delay of the second cycle of chemotherapy. Patient & treatment characteristics were captured to assess for risk factors for developing MJP. A pain diary assessed MJP severity, its management and impact on everyday activities. It was completed starting the evening of chemotherapy for 14 consecutive days. Statistical analysis was performed with Stata 12, including multi-level longitudinal mixed models for MJP scores. Results: 140 pts were enrolled with mean age 52 yr and 58% receiving docetaxel-based chemotherapy. One-third received F and two-thirds received P. Both diary muscle and joint pain peaked in prevalence and severity on days 3 to 6. Over 50% of pts reported MJP at the peak. Pain that increased ≥3 points from baseline was reported by 48% of pts. Daily activities were affected in 48% of 1,960 reporting-days, with 26% reporting moderate or severe impairment. Despite similar incidences of pain, P was associated with lower mean muscle (p=0.0049) and joint (p=0.014) pain scores by regression analyses. FN and N were not different. Use of docetaxel was the sole baseline risk factor for developing MJP. Conclusions: Patients experience substantial MJP with impairment of daily activities but pts receiving pegfilgrastim experience less pain and less burden relating to pain.

Proper dosage of primary pegylated G-CSF prophylactic use for breast cancer patients receiving adjuvant or neo-adjuvant chemotherapy.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18354-e18354
Author(s):  
Liang Yu ◽  
Xin Lei ◽  
Ying Lin
Keyword(s):  
Breast Cancer ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Cancer Patients ◽  
Logistic Regression Analysis ◽  
Insurance Coverage ◽  
Breast Cancer Patients ◽  
Treatment Delays ◽  
Surgical Department ◽  
Dose Reductions

e18354 Background: Myelosuppression during chemotherapy can lead to life-threatening infections, dose reductions, treatment delays, as well as prolonged hospitalizations, early morbidity, and early mortality. According to NCCN guideline, Pegfilgrastim 6mg per cycle is recommended for breast cancer patients receiving chemotherapy, and dosage modification based on body weight is not required. However, primary PEGylated G-CSF prophylaxis comes with significant extra cost, which has a great impact on health care resources, especially for patients without insurance coverage. Methods: We analyzed clinical data of patients, weighing between 45 and 65 kilogram, received a single subcutaneous PEGylated recombinant human G-CSF injection at fixed doses of either 3 mg or 6 mg per chemotherapy cycle approximately 24 hours after completion of each cycle of chemotherapy. Data for this retrospective study were obtained from Thyroid and Breast Surgical Department of the First Affiliated Hospital of Sun Yat-sen University between July 1, 2017, and October 31, 2017. Results: 41 cycles in 33 patients were included in 3mg PEGylated G-CSF group, and 46 cycles in 39 patients were included in 6mg PEGylated G-CSF group. Among chemotherapy cycles, the incidence of neutropenic event was19.5%and 2.2% in 3mg PEGylated G-CSF group and 6mg PEGylated G-CSF group, respectively. No patients experienced dose reductions or treatment delays in both groups. Using single-factor Logistic Regression Analysis, we found that dose of PEGylated G-CSF(3mg vs 6mg) was significantly associated with occurrence of neutropenic event(p = 0.028). Multi-factor Logistic Regression Analysis also showed that dose of PEGylated G-CSFwas significantly associated with occurrence of neutropenic event (p = 0.031). Conclusions: Our study showed that dose of prophylactic PEGylated G-CSF was significantly associated with occurrence of neutropenic events. So adequate dose of PEGylated G-CSF is important to reduce chemotherapy induced neutropenic events and to guarantee the quality of chemotherapy in patients with breast cancer.

Financial and employment toxicity related to breast reconstruction following mastectomy in a diverse population-based cohort.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 78-78
Author(s):  
Nicholas L. Berlin ◽  
Adeyiza O. Momoh ◽  
Paul Abrahamse ◽  
Steven J. Katz ◽  
Reshma Jagsi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Reconstruction ◽  
Employment Status ◽  
Early Stage ◽  
Insurance Coverage ◽  
The United States ◽  
Population Based ◽  
Early Stage Breast Cancer ◽  
Financial Barriers ◽  
Spanish Speaking

78 Background: Despite mandated private insurance coverage for breast reconstruction following mastectomy, health care costs are increasingly passed onto women who seek these procedures through cost-sharing arrangements and high-deductible health plans. In this population-based study, we sought to characterize financial and employment toxicities related to pursuing breast reconstruction following mastectomy. Methods: Women (white, African American, and Latina-English and Spanish speaking) with early stage breast cancer (stages 0-II) diagnosed between July 2013 to September 2014 and who underwent mastectomy were identified through the Georgia and Los Angeles Surveillance, Epidemiology, and End Results (SEER) registries and surveyed. Primary outcome measures included patient-reported appraisal of financial toxicity and employment status following breast cancer treatment using previously developed measures. Multivariable models evaluated the association between breast reconstruction and self-reported financial and employment status. Results: Among 868 breast cancer patients who underwent mastectomy, 43.5% (n = 378) did not undergo breast reconstruction and 56.5% (n = 490) underwent reconstruction. 43.4% of the cohort reported being worse off financially since their diagnosis (49.4% with reconstruction vs. 35.0% without reconstruction, P< .001). Among women who were employed at time of breast cancer diagnosis (n = 535), 70.2% who underwent reconstruction reported being worse off regarding employment status compared to 51.1% who did not undergo reconstruction ( P< .001). Receipt of reconstruction was independently associated with a self-reported decline in financial status (Odds Ratio (OR) 2.1, 95% Confidence Interval (CI) 1.4-3.4, P= .001). Similarly, reports of being worse off regarding employment status were also higher in those who underwent reconstruction vs. not (OR 2.2, 95% CI 1.2-3.8, P= .006). Spanish-speaking Latina women more often reported being worse off regarding employment status (OR 4.3, 95% CI 2.1-9.0, P< .001) than white women. Conclusions: In this diverse cohort of women who underwent mastectomy for early stage breast cancer, women who elected to undergo reconstruction experienced more self-reported financial and employment toxicities. Patients should be counseled regarding the potential costs related to these procedures. Policy-makers should be aware of the financial barriers for women who undergo reconstruction despite mandatory insurance coverage in the United States.

The Relation between Health Insurance Coverage and Clinical Outcomes among Women with Breast Cancer

1993 ◽  
Vol 329 (5) ◽  
pp. 326-331 ◽  
Author(s):  
John Z. Ayanian ◽  
Betsy A. Kohler ◽  
Toshi Abe ◽  
Arnold M. Epstein
Keyword(s):  
Breast Cancer ◽  
Health Insurance ◽  
Clinical Outcomes ◽  
Insurance Coverage ◽  
Health Insurance Coverage
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