The Lynx Group

Breast Cancer Treatment Still Under Par for Patients Covered by Medicaid

October 2011, Vol 2, No 6

San Francisco, CA—Several studies presented at the 2011 Breast Cancer Symposium shed light on the quality of breast cancer care received by women who are uninsured or receiving Medicaid.

In a study conducted at Rollins School of Public Health of Emory University, Atlanta, researchers investigated the quality of breast cancer treatment in patients enrolled under Medicaid and the Breast and Cervical Cancer Prevention and Treatment Act (BCCPTA) of 2000 in Georgia.

The BCCPTA allows states to cover women diagnosed with breast or cervical cancer or those with precancerous cervical conditions under Medicaid at the time of diagnosis and while they receive treatment. Women must not be eligible for Medicaid under another mandatory covered group and must not have other health insurance.

The study included 2048 Medicaid enrollees, of whom 1046 were covered under the BCCPTA, 674 were disabled, and 328 had “other” types of Medicaid eligibility. The researchers calculated the odds of receiving various types of treatment according to these various groups.

After controlling for covariates, BCCPTA-covered women were more likely to receive any treatment (odds ratio [OR], 4.71), any drug regimen (OR, 3.58), any radiation therapy (OR, 1.61), or any definitive surgery (OR, 2.52) than other eligibility groups; disabled patients were more likely to receive recommended treatments than “other” patients.

For example, treatment with “any drug” was given to 90% of patients covered under the BCCPTA and 83% of disabled patients versus 67% of “other” patients. Radiation therapy was administered to 61%, 50%, and 45% of patients, respectively, according to E. Kathleen Adams, PhD, Associate Professor of Health Policy and Management, Rollins School of Public Health.

No significant differences were found in the use of a lumpectomy versus a mastectomy based on an eligibility group, but women covered under the BCCPTA were more likely to receive adjuvant treatment.

“The BCCPTA program in Georgia appears to create a quicker pathway for previously low-income uninsured women with breast cancer to access services and, in turn, receive more treatment than women enrolled in more traditional Medicaid eligibility groups,” Dr Adams said. “Yet the overall rate of adjuvant therapy, whether radiation or hormonal or chemotherapy, appears to fall short of national criteria.”

Worse Outcomes in Uninsured/ Medicaid Patients

In a study from Michigan State University in Flint, 632 patients with breast cancer were analyzed according to race and insurance status. Patients with Medicaid or no insurance had a significantly lower overall survival rate at 5 years than patients with private insurance (P <.001) or who re ceived Medicare disability benefits (P = .006).

At 5 years, 76% of patients with private insurance and 75% of those with Medicare disability were alive compared with only 49% of those with Medicaid or no insurance, as reported by Mohammad Omaira, MD, a hematology/oncology fellow at Michigan State University, and colleagues.

Although black patients were significantly more likely to present at an advanced stage of disease, this finding lost statistical significance after adjustment for insurance status. “Not all segments of the US population have experienced equal benefits from the major advances in early diagnosis and treatment of breast cancer,” the authors noted. —AA

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