Can Regionalization of Care Reduce Socioeconomic Disparities in Breast Cancer Survival?

Abstract

Background: Breast cancer patients of low socioeconomic status (SES) have worse survival than more affluent women and are also more likely to undergo surgery in low-volume facilities. Since breast cancer patients treated in high-volume facilities have better survival, regionalizing the care of low SES patients toward high-volume facilities might reduce SES disparities in survival. Objective: We leverage a natural experiment in New York state to examine whether a policy precluding payment for breast cancer surgery for New York Medicaid beneficiaries undergoing surgery in low-volume facilities led to reduced SES disparities in mortality. Research Design: A multivariable difference-in-differences regression analysis compared mortality of low SES (dual enrollees, Medicare-Medicaid) breast cancer patients to that of wealthier patients exempt from the policy (Medicare only) for time periods before and after the policy implementation. Subjects: A total of 14,183 Medicare beneficiaries with breast cancer in 2006–2008 or 2014–2015. Measures: All-cause mortality at 3 years after diagnosis and Medicaid status, determined by Medicare administrative data. Results: Both low SES and Medicare-only patients had better 3-year survival after the policy implementation. However, the decline in mortality was larger in magnitude among the low SES women than others, resulting in a 53% smaller SES survival disparity after the policy after adjustment for age, race, and comorbid illness. Conclusion: Regionalization of early breast cancer care away from low-volume centers may improve outcomes and reduce SES disparities in survival.

Cancer‐Specific health equity metrics in the United States of America: A scoping review

“…Third, and closely related, access to patient navigation during screening and treatment can positively impact cancer‐related health equity 31,32 . Use of technology to identify patients who may benefit from navigation 31 as well as policies to reduce financial burden associated with cancer treatment may positively influence timeliness in receiving treatment and reduce disparities in mortality 35 . Of note, Patel and colleagues 59–61 have an ongoing study that tests an intervention designed to improve advance care planning and symptom management among low‐income and minority hourly‐wage workers with cancer by providing a lay health worker to all patients newly diagnosed with cancer.…”

Rural-Urban Differences in Breast Cancer Surgical Delays in Medicare Beneficiaries

“… 32 , 41 A recent study by Nattinger et al found New York State’s 2009 policy limiting Medicaid reimbursements to facilities where ≥ 30 all-payer breast cancer operations were performed annually appeared to improve survival for both Medicaid and Medicare patients. 42 If future regionalization efforts supporting dedicated breast cancer programs also consider surgeon caseloads, benefits to rural patients may be optimized.…”

Centralization of Initial Care and Improved Survival of Poor Patients With Breast Cancer

“…The New York State Cancer Registry (NYSCR) 15 was the source of data on incident breast cancers among women during the study years. Given that women age 65 years and older typically have Medicare coverage, and thus additional source of payment other than Medicaid, 16 we limited this analysis to women age < 65 years at diagnosis. We identified cohorts of women who developed stage I-III breast cancer during calendar years 2004-2008 (termed prepolicy) and 2010-2013 (termed postpolicy).…”