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Lin J, Shriver CD, Zhu K. Survival among lung cancer patients: comparison of the U.S. military health system and the surveillance, epidemiology, and end results (SEER) program by health insurance status. Cancer Causes Control 2024; 35:21-31. [PMID: 37532916 DOI: 10.1007/s10552-023-01765-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/19/2023] [Indexed: 08/04/2023]
Abstract
PURPOSE The U.S. military health system (MHS) provides beneficiaries with universal health care while health care access varies in the U.S. general population by insurance status/type. We divided the patients from the U.S. general population by insurance status/type and compared them to the MHS patients in survival. METHODS The MHS patients were identified from the Department of Defense's Automated Central Tumor Registry (ACTUR). Patients from the U.S. general population were identified from the Surveillance, Epidemiology, and End Results (SEER) program. Multivariable Cox regression analysis was conducted to compare different insurance status/type in SEER to ACTUR in overall survival. RESULTS Compared to ACTUR patients with non-small cell lung cancer (NSCLC), SEER patients showed significant worse survival. The adjusted hazard ratios (HRs) were 1.08 [95% Confidence Interval (CI) = 1.03-1.13], 1.22 (95% CI = 1.16-1.28), 1.40 (95% CI = 1.33-1.47), 1.50 (95% CI = 1.41-1.59), for insured, insured/no specifics, Medicaid, and uninsured patients, respectively. The pattern was consistently observed in subgroup analysis by race, gender, age, or tumor stage. Results were similar for small cell lung cancer (SCLC), although they were only borderline significant in some subgroups. CONCLUSION The survival advantage of patients receiving care from a universal health care system over the patients from the general population was not restricted to uninsured or Medicaid as expected, but was present cross all insurance types, including patients with private insurance. Our findings highlight the survival benefits of universal health care system to lung cancer patients.
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Affiliation(s)
- Jie Lin
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, 6720A Rockledge Drive, Suite 310, Bethesda, MD, 20817, USA.
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, 20817, USA.
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA.
| | - Craig D Shriver
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, 6720A Rockledge Drive, Suite 310, Bethesda, MD, 20817, USA
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD, 20814, USA
| | - Kangmin Zhu
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, 6720A Rockledge Drive, Suite 310, Bethesda, MD, 20817, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, 20817, USA
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
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Hoppe A, Hirko K, Wendling A. Understanding the burden of colorectal cancer in a three-county rural region of Michigan: an ecological analysis of incidence, mortality, and risk factors. Cancer Causes Control 2024; 35:153-159. [PMID: 37608035 DOI: 10.1007/s10552-023-01776-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 08/07/2023] [Indexed: 08/24/2023]
Abstract
PURPOSE Our aim was to identify whether known colorectal cancer (CRC) risk factors contribute to the high CRC burden in Michigan's Thumb region, a 3-county agricultural rural area in eastern Michigan. METHODS We examined county-level invasive CRC incidence and mortality rates (2000-2017) from the Michigan Cancer Surveillance Program and county-level data on CRC risk factors from publicly available datasets. Prevalence of CRC risk factors in the Thumb region were compared to Michigan's other rural and urban regions using ANOVA (Analysis of Variance) tests. Multivariable linear regression models with stepwise selection were used to assess whether living in the Thumb region was associated with increased CRC incidence, mortality, and late-stage diagnoses after accounting for other risk factors. RESULTS Living in the Thumb region (β = 10.4, p = 0.0003), obesity (β = 36.9, p = 0.04), and an unhealthy food environment (β = - 2.7, p = 0.003) were associated with higher CRC incidence. Smoking (β = 67.3, p < 0.0001), being uninsured (β = - 29.9%, p = 0.03), living in the Thumb region (β = 2.47, p = 0.03), lower colonoscopy screening (β = - 0.14, p = 0.01), and older age (β = 0.11, p = 0.006) were associated with higher CRC mortality. The percent of late-staged CRC diagnoses was significantly lower in the Thumb region than other rural and urban areas of the state (52.9%, 58.3%, and 54.6%, respectively, p = 0.03). CONCLUSION Findings suggest that living in Michigan's Thumb region is associated with higher CRC incidence and mortality compared to Michigan's other rural and urban regions, even after controlling for known risk factors. More studies on individual-level demographic, environmental, tumor, and treatment characteristics (e.g., treatment differences, water quality, pesticide use) are needed to further characterize these findings.
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Affiliation(s)
- Allison Hoppe
- Corewell Health General Surgery Residency, 100 Michigan Street, Suite A601, Grand Rapids, MI, 49503, USA.
- Department of Surgery, College of Human Medicine, Michigan State University, East Lansing, MI, USA.
| | - Kelly Hirko
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Andrea Wendling
- Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA
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Reif de Paula T, Keller DS. A national evaluation of adjuvant chemotherapy in pT4N0M0 colon cancer from the National Cancer Database. J Natl Cancer Inst 2023; 115:1616-1625. [PMID: 37584736 DOI: 10.1093/jnci/djad164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/24/2023] [Accepted: 08/13/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND T stage is a prognostic biomarker for overall survival in colon cancer and pathologic T4 disease is a high-risk characteristic. Adjuvant chemotherapy is recommended to improve overall survival in pT4N0M0, but compliance with guidelines is unknown. We aimed to evaluate adjuvant chemotherapy use and impact on overall survival in pT4N0M0 colon cancer. METHODS The National Cancer Database was reviewed for pT4N0M0 colon adenocarcinomas undergoing curative surgical resection (2010-2017). Cases were stratified into no adjuvant chemotherapy and adjuvant chemotherapy cohorts. Moderated multiple regression assessed factors associated with no AC. Kaplan-Meier and Cox regression assessed overall survival in propensity-score matched cohorts. The main outcome measures were adjuvant chemotherapy use, factors associated with adjuvant chemotherapy, and impact on overall survival. RESULTS Of 11 847 cases, 62.4% (n = 7391) received no adjuvant chemotherapy. With private insurance, comorbidities or income do not affect adjuvant chemotherapy use. Medicare cases with a Charlson-Deyo comorbidity index of 0 (odds ratio [OR] = 0.861, 95% confidence interval [CI] = 0.760 to 0.975; P = .019) and Medicare payors with high income (OR = 0.813, 95% CI = 0.690 to 0.959; P = .014) were associated with adjuvant chemotherapy. Medicaid Charlson-Deyo comorbidity index 0 (OR = 1.374, 95% CI = 1.125 to 1.679; P = .002) and uninsured Charlson-Deyo comorbidity index 0 (OR = 1.351, 95% CI = 1.120 to 1.629; P = .002) were associated with no adjuvant chemotherapy. Adjuvant chemotherapy was associated with improved 5-year overall survival (71.7% vs 56.4%; P < .001; adjusted hazard ratio = 0.543, 95% CI = 0.499 to 0.590; P < .001). CONCLUSION Although adjuvant chemotherapy is associated with improved overall survival, compliance is low. There is a complex relationship between payor, income, comorbidity, and adjuvant chemotherapy receipt. Medicare patients with no comorbidities or higher income have better adjuvant chemotherapy use. With private insurance, adjuvant chemotherapy compliance is not affected by comorbidities or income, whereas Medicaid and uninsured patients with no comorbidities have poor compliance. Future work could target these disparities for equitable care.
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Affiliation(s)
- Thais Reif de Paula
- Lankenau Institute for Medical Research, Lankenau Medical Center, Wynnewood, PA, USA
| | - Deborah S Keller
- Lankenau Institute for Medical Research, Lankenau Medical Center, Wynnewood, PA, USA
- Department of Surgery, Lankenau Medical Center, Marks Colorectal Surgical Associates, Wynnewood, PA, USA
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Kubi B, Nudotor R, Fackche N, Rowe J, Cloyd JM, Ahmed A, Grotz TE, Fournier K, Dineen S, Veerapong J, Baumgartner JM, Clarke C, Patel SH, Dhar V, Lambert L, Abbott DE, Pokrzywa C, Raoof M, Lee B, Zaidi MY, Maithel SK, Johnston FM, Greer JB. Influence of insurance status on the postoperative outcomes of cytoreductive surgery and HIPEC. J Surg Oncol 2023; 127:706-715. [PMID: 36468401 DOI: 10.1002/jso.27147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/19/2022] [Accepted: 11/09/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is increasingly performed for peritoneal surface malignancies but remains associated with significant morbidity. Scant research is available regarding the impact of insurance status on postoperative outcomes. METHODS Patients undergoing CRS/HIPEC between 2000 and 2017 at 12 participating sites in the US HIPEC Collaborative were identified. Univariate and multivariate analyses were used to compare the baseline characteristics, operative variables, and postoperative outcomes of patients with government, private, or no insurance. RESULTS Among 2268 patients, 699 (30.8%) had government insurance, 1453 (64.0%) had private, and 116 (5.1%) were uninsured. Patients with government insurance were older, more likely to be non-white, and comorbid (p < 0.05). Patients with government (OR: 2.25, CI: 1.50-3.36, p < 0.001) and private (OR: 1.69, CI: 1.15-2.49, p = 0.008) insurance had an increased risk of complications on univariate analysis. There was no independent relationship on multivariate analysis. An American Society of Anesthesiologists score of 3 or 4, peritoneal carcinomatosis index score >15, completeness of cytoreduction score >1, and nonhome discharge were factors independently associated with a postoperative complication. CONCLUSION While there were differences in postoperative outcomes between the three insurance groups on univariate analysis, there was no independent association between insurance status and postoperative complications after CRS/HIPEC.
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Affiliation(s)
- Boateng Kubi
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Richard Nudotor
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nadege Fackche
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Julian Rowe
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jordan M Cloyd
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ahmed Ahmed
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Travis E Grotz
- Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Keith Fournier
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sean Dineen
- Department of Gastrointestinal Oncology and Oncologic Sciences, Moffitt Cancer Center, Morsani College of Medicine, Tampa, Florida, USA
| | - Jula Veerapong
- Department of Surgery, Division of Surgical Oncology, University of California, San Diego, California, USA
| | - Joel M Baumgartner
- Department of Surgery, Division of Surgical Oncology, University of California, San Diego, California, USA
| | - Callisia Clarke
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sameer H Patel
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Vikrom Dhar
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Laura Lambert
- Department of Surgery, Division of Surgical Oncology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Daniel E Abbott
- Department of Surgery, Division of Surgical Oncology, University of Wisconsin, Madison, Wisconsin, USA
| | - Courtney Pokrzywa
- Department of Surgery, Division of Surgical Oncology, University of Wisconsin, Madison, Wisconsin, USA
| | - Mustafa Raoof
- Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Byrne Lee
- Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Mohammad Y Zaidi
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Shishir K Maithel
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Fabian M Johnston
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jonathan B Greer
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA
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Ong CT, Dhiman A, Smith A, Jose A, Kallakuri P, Belanski J, Sood D, Witmer HDD, Morgan RB, Turaga KK, Eng OS. Insurance Authorization Barriers in Patients Undergoing Cytoreductive Surgery and HIPEC. Ann Surg Oncol 2023; 30:417-422. [PMID: 36112250 DOI: 10.1245/s10434-022-12437-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/06/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Indications for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) exist across multiple histologies, but little data exist on the impact of insurance authorization on access to these therapies. Given the evolving role of CRS/HIPEC, we sought to characterize insurance approval and delays in patients undergoing these therapies. PATIENTS AND METHODS A retrospective review was performed at a high-volume tertiary center of patients who received CRS/HIPEC from 2017 to 2021. Collected data included patient demographics, tumor histologic characteristics, insurance type, approval/denial history, and time to prior authorization approval. Descriptive statistics were performed. RESULTS In total, 367 patients received CRS/HIPEC during the study period. They had a median age of 59 (IQR 49-67) years, 35% were male, and 76% were white. Of the patients requiring prior authorization, 14 of 104 (13%) patients were denied prior authorization and required appeal. Median time between authorization request and approval was 33 (IQR 28-36) days. These cases generated 410 insurance authorization requests, 94 (23%) of which were not initially approved and required appeal. The rate of upfront denial was 21.1% in patients with public insurance compared with 23.4% in patients with private insurance. Gastric cancer was the most common histology among denied cases (55%), followed by colorectal, appendiceal, and gynecologic malignancies. CONCLUSIONS Despite the broadening indications for and data supporting CRS/HIPEC, a significant proportion of patients still face hurdles in attaining insurance approval and coverage for these therapies. Addressing barriers to insurance approval is imperative to decrease therapeutic delay and improve access to data-driven care.
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Affiliation(s)
- Cecilia T Ong
- Department of Surgery, University of Chicago, Chicago, USA
| | - Ankit Dhiman
- Department of Surgery, University of Chicago, Chicago, USA
| | - Anthony Smith
- Department of Surgery, University of Chicago, Chicago, USA
| | - Angela Jose
- Department of Surgery, University of Chicago, Chicago, USA
| | | | | | - Divya Sood
- Department of Surgery, University of Chicago, Chicago, USA
| | | | - Ryan B Morgan
- Department of Surgery, University of Chicago, Chicago, USA
| | - Kiran K Turaga
- Department of Surgery, University of Chicago, Chicago, USA
| | - Oliver S Eng
- Department of Surgery, University of California, Irvine, Orange, USA.
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Sharma M, Wang D, Palmisciano P, Ugiliweneza B, Woo S, Nelson M, Miller D, Savage J, Boakye M, Andaluz N, Mistry AM, Chen CC, Williams BJ. Is intraoperative MRI use in malignant brain tumor surgery a health care burden? A matched analysis of MarketScan Database. J Neurooncol 2022; 160:331-339. [DOI: 10.1007/s11060-022-04142-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 09/20/2022] [Indexed: 10/31/2022]
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Sharma M, Ball T, Wang D, Ugiliweneza B, Rattani A, Woo S, Boakye M, Neimat JS, Williams B, Andaluz N. Incidence of repeat procedures and healthcare utilization following surgery, radiosurgery, and percutaneous procedures in elderly patients with trigeminal neuralgia. J Neurosurg 2022; 137:828-839. [PMID: 35090128 DOI: 10.3171/2021.12.jns211880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/02/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Management of trigeminal neuralgia (TN) in elderly patients poses significant challenges. The impact of different treatment modalities (surgery, radiosurgery [RS], and percutaneous techniques [PTs]) on healthcare utilization is not well defined in the management of TN in elderly patients. The aim of this study was to compare the long-term healthcare utilization metrics of different interventions in the management of elderly patients with TN. METHODS The MarketScan database was queried using the International Classification of Diseases, Ninth Revision and Current Procedural Terminology, from 2000 to 2016. TN patients ≥ 65 years of age managed using surgery, RS, and PTs with at least 5 years of follow-up after the index procedure were included. Outcomes analyzed were hospital admissions, outpatient services, and medication refills. RESULTS Of 993 patients, 43% (n = 430) underwent RS, 44% (n = 432) had PTs, and only 13% (n = 131) underwent surgery for TN. Overall, the median age of patients was 74 years old, 64% were females, 90% had Medicare insurance, and 17% had an Elixhauser index ≥ 3. Patients in the surgery group were younger (median age 71 years) with a higher comorbidity index (≥ 3; 24%) compared with patients undergoing RS and PTs (13% and 17%, respectively). At 1, 2, and 5 years after the index procedure, 41%, 48%, and 57% of patients in the PT cohort underwent any repeat procedure compared with 11%, 18%, and 29% for the RS cohort, and 6%, 9%, and 11% for the surgical cohort, respectively. Also, patients in the PT cohort incurred 1.8, 1.9, and 2.0 times the combined payment at 1, 2, and 5 years, respectively, compared with the surgery cohort. Similarly, patients who underwent RS for TN incurred 1.4, 1.5, and 1.5 times the combined payment at 1, 2, and 5 years, respectively, compared with the surgery cohort. At 5 years after the index procedure, combined payments for the PT cohort were $79,753 (IQR $46,013, $144,064) compared with $61,016 (IQR $27,114, $117,097) for the RS cohort and $41,074 (IQR $25,392, $87,952) for the surgery cohort (p < 0.0001). CONCLUSIONS PTs followed by RS were the common procedures used in the majority of elderly patients with TN. However, surgery for TN resulted in durable control with the least need for reoperations up to 5 years after the index procedure, followed by RS and PTs. PTs for TN resulted in the highest utilization of healthcare resources and need for reoperations at all time points. These findings should be considered in clinical decision-making when selecting appropriate treatment modalities in elderly patients with TN.
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Affiliation(s)
- Mayur Sharma
- 1Department of Neurosurgery, University of Louisville, Kentucky
| | - Tyler Ball
- 2Department of Neurosurgery, Vanderbilt University, Nashville, Tennessee
| | - Dengzhi Wang
- 1Department of Neurosurgery, University of Louisville, Kentucky
| | | | - Abbas Rattani
- 3Department of Radiation Oncology, James Graham Brown Cancer Center, University of Louisville, Kentucky; and
| | - Shiao Woo
- 3Department of Radiation Oncology, James Graham Brown Cancer Center, University of Louisville, Kentucky; and
| | - Maxwell Boakye
- 1Department of Neurosurgery, University of Louisville, Kentucky
| | - Joseph S Neimat
- 1Department of Neurosurgery, University of Louisville, Kentucky
| | - Brian Williams
- 1Department of Neurosurgery, University of Louisville, Kentucky
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Sharma M, Jain N, Dietz N, Wang D, Ugiliweneza B, Drazin D, Boakye M. Incidence of New Onset Dementia and Health Care Utilization Following Spine Fusions: A Propensity Score Matching Analysis. Neurochirurgie 2022; 68:562-568. [PMID: 35932885 DOI: 10.1016/j.neuchi.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Dementia following spine fusions is not described in the literature. Also, the impact of new onset dementia on long-term health care utilization is not described. The aim of our study was to define the incidence of new onset dementia and its long-term health care utilization in elderly patients. MATERIALS AND METHODS MarketScan database were queried using the ICD-9/10 and CPT 4th edition, from 2001 to 2019. We included patients ≥ 55 of age who underwent spine fusions with at least 5 years follow-up. Outcomes were new onset dementia (> 6 months after the procedure) length of stay (LOS), discharge disposition, hospital re-admissions, outpatient services, and medication refills. RESULTS Of 45,129 patients who underwent spine fusions, 1283 patients (2.84%) were diagnosed to have new-onset dementia. There was no difference in the re-operation rates among the dementia and non-dementia cohort at 1-, 2- and 5-years following the index procedure. Patients in the dementia cohort incurred higher number of hospital re-admissions up to 5-years after the index procedure. In terms of combined index procedure and post-discharge utilization payments, significant differences were noted among the dementia vs. non-dementia cohorts at 5-years ($126,628 vs. $ 77,098), following the index procedure. CONCLUSION Elderly age, higher comorbidities, Medicare insurance, multi-level lumbosacral fusions were identified as risk markers for developing dementia following spine fusions. Dementia resulted in significantly higher health care utilization with no increased rate of re-operations for up to 5-years following the index procedure.
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Affiliation(s)
- Mayur Sharma
- Department of Neurosurgery, University of Louisville, 200 Abraham Flexner Hwy, 40202 Louisville, KY, U.S.A.
| | - Nikhil Jain
- Department of Orthopedics, Boston University Medical Center, Boston, MA 02118, U.S.A
| | - Nicholas Dietz
- Department of Neurosurgery, University of Louisville, 200 Abraham Flexner Hwy, 40202 Louisville, KY, U.S.A
| | - Dengzhi Wang
- Department of Neurosurgery, University of Louisville, 200 Abraham Flexner Hwy, 40202 Louisville, KY, U.S.A; Kentucky Spinal Cord Injury Research Center, University of Louisville, 200 Abraham Flexner Hwy, 40202 Louisville, KY, U.S.A
| | - Beatrice Ugiliweneza
- Department of Neurosurgery, University of Louisville, 200 Abraham Flexner Hwy, 40202 Louisville, KY, U.S.A; Kentucky Spinal Cord Injury Research Center, University of Louisville, 200 Abraham Flexner Hwy, 40202 Louisville, KY, U.S.A; Department of Health Management and Systems Sciences, University of Louisville, 485 E. Gray St, Louisville, KY 40202, U.S.A
| | - Doniel Drazin
- Evergreen Hospital Neuroscience Institute, 98034 Kirkland, WA, U.S.A
| | - Maxwell Boakye
- Department of Neurosurgery, University of Louisville, 200 Abraham Flexner Hwy, 40202 Louisville, KY, U.S.A; Kentucky Spinal Cord Injury Research Center, University of Louisville, 200 Abraham Flexner Hwy, 40202 Louisville, KY, U.S.A
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Choy AM, Lebwohl B, Krigel A. Impact of social determinants of health on colorectal cancer screening and surveillance in the COVID reopening phase. Eur J Gastroenterol Hepatol 2022; 34:739-743. [PMID: 35102113 PMCID: PMC9169755 DOI: 10.1097/meg.0000000000002350] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/10/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND/AIMS Procedural delays due to the coronavirus disease 2019 (COVID-19) pandemic may exacerbate disparities in colorectal cancer (CRC) preventive care. We aimed to measure racial and socioeconomic disparities in the prioritization of CRC screening or adenoma surveillance during the COVID reopening period. METHODS We identified CRC screening or surveillance colonoscopies performed during two time periods: (1) 9 June 2019-30 September 2019 (pre-COVID) and (2) 9 June 2020-30 September 2020 (COVID reopening). We recorded the procedure indication, patient age, sex, race/ethnicity, primary language, insurance status and zip code. Multivariable logistic regression was used to determine factors independently associated with undergoing colonoscopy in the COVID reopening era. RESULTS We identified 1473 colonoscopies for CRC screening or adenoma surveillance; 890 occurred in the pre-COVID period and 583 occurred in the COVID reopening period. In total 342 (38.4%) pre-COVID patients underwent adenoma surveillance and 548 (61.6%) underwent CRC screening; in the COVID reopening cohort, 257 (44.1%) underwent adenoma surveillance and 326 (55.9%) underwent CRC screening (P = 0.031). This increased proportion of surveillance procedures in the reopening cohort was statistically significant on multivariable analysis [odds ratio (OR), 1.26; 95% confidence interval (CI), 1.001-1.58]. Black patients comprised 17.4% of the pre-COVID cohort, which declined to 15.3% (P = 0.613). There was a trend toward an inverse association between reopening phase colonoscopy and Medicaid insurance compared with commercial insurance (OR, 0.71; 95% CI, 0.49-1.04). No significant associations were found between reopening phase colonoscopy and the remaining variables. CONCLUSIONS During the COVID reopening period, colonoscopies for CRC fell by over one-third with significantly more surveillance than screening procedures. Nonwhite patients and non-English speakers comprised a shrinking proportion in the COVID reopening period.
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Affiliation(s)
- Alexa M Choy
- Department of Medicine, Columbia University Medical Center, New York, USA
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10
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Jones LA, Brewer KC, Carnahan LR, Parsons JA, Polite BN, Ferrans CE, Warnecke RB, Rauscher GH. Health Insurance Status as a Predictor of Mode of Colon Cancer Detection but Not Stage at Diagnosis: Implications for Early Detection. Public Health Rep 2022; 137:479-487. [PMID: 33789522 PMCID: PMC9109539 DOI: 10.1177/0033354921999173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE For colon cancer patients, one goal of health insurance is to improve access to screening that leads to early detection, early-stage diagnosis, and polyp removal, all of which results in easier treatment and better outcomes. We examined associations among health insurance status, mode of detection (screen detection vs symptomatic presentation), and stage at diagnosis (early vs late) in a diverse sample of patients recently diagnosed with colon cancer from the Chicago metropolitan area. METHODS Data came from the Colon Cancer Patterns of Care in Chicago study of racial and socioeconomic disparities in colon cancer screening, diagnosis, and care. We collected data from the medical records of non-Hispanic Black and non-Hispanic White patients aged ≥50 and diagnosed with colon cancer from October 2010 through January 2014 (N = 348). We used logistic regression with marginal standardization to model associations between health insurance status and study outcomes. RESULTS After adjusting for age, race, sex, and socioeconomic status, being continuously insured 5 years before diagnosis and through diagnosis was associated with a 20 (95% CI, 8-33) percentage-point increase in prevalence of screen detection. Screen detection in turn was associated with a 15 (95% CI, 3-27) percentage-point increase in early-stage diagnosis; however, nearly half (47%; n = 54) of the 114 screen-detected patients were still diagnosed at late stage (stage 3 or 4). Health insurance status was not associated with earlier stage at diagnosis. CONCLUSIONS For health insurance to effectively shift stage at diagnosis, stronger associations are needed between health insurance and screening-related detection; between screening-related detection and early stage at diagnosis; or both. Findings also highlight the need to better understand factors contributing to late-stage colon cancer diagnosis despite screen detection.
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Affiliation(s)
- Lindsey A. Jones
- Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Katherine C. Brewer
- Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Leslie R. Carnahan
- Division of Community Health Sciences, School of Public Health,
University of Illinois at Chicago, Chicago, IL, USA
- Center for Research on Women and Gender, College of Medicine,
University of Illinois at Chicago, Chicago, IL, USA
| | - Jennifer A. Parsons
- Survey Research Laboratory, University of Illinois at Chicago,
Chicago, IL, USA
| | - Blase N. Polite
- School of Medicine, University of Chicago, Chicago, IL,
USA
| | - Carol Estwing Ferrans
- Institute for Health Research and Policy, University of Illinois at
Chicago, Chicago, IL, USA
- College of Nursing, University of Illinois at Chicago, Chicago, IL,
USA
| | - Richard B. Warnecke
- Institute for Health Research and Policy, University of Illinois at
Chicago, Chicago, IL, USA
| | - Garth H. Rauscher
- Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, IL, USA
- Institute for Health Research and Policy, University of Illinois at
Chicago, Chicago, IL, USA
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11
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Mason MC, Krasnodebski M, Hester CA, Kothari AN, Barker C, Nishioka Y, Chiang YJ, Newhook TE, Tzeng CWD, Chun YS, Vauthey JN, Tran Cao HS. Outcomes of Mixed Pathologic Response in Patients with Multiple Colorectal Liver Metastases Treated with Neoadjuvant Chemotherapy and Liver Resection. Ann Surg Oncol 2022; 29:5156-5164. [DOI: 10.1245/s10434-022-11683-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/08/2022] [Indexed: 11/18/2022]
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Montiel Ishino FA, Odame EA, Villalobos K, Whiteside M, Mamudu H, Williams F. Applying Latent Class Analysis on Cancer Registry Data to Identify and Compare Health Disparity Profiles in Colorectal Cancer Surgical Treatment Delay. J Public Health Manag Pract 2022; 28:E487-E496. [PMID: 33729186 PMCID: PMC8435045 DOI: 10.1097/phh.0000000000001341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Colorectal cancer (CRC) surgical treatment delay (TD) has been associated with mortality and morbidity; however, disparities by TD profiles are unknown. OBJECTIVES This study aimed to identify CRC patient profiles of surgical TD while accounting for differences in sociodemographic, health insurance, and geographic characteristics. DESIGN We used latent class analysis (LCA) on 2005-2015 Tennessee Cancer Registry data of CRC patients and observed indicators that included sex/gender, age at diagnosis, marital status (single/married/divorced/widowed), race (White/Black/other), health insurance type, and geographic residence (non-Appalachian/Appalachian). SETTING The state of Tennessee in the United States that included both Appalachian and non-Appalachian counties. PARTICIPANTS Adult (18 years or older) CRC patients (N = 35 412) who were diagnosed and surgically treated for in situ (n = 1286) and malignant CRC (n = 34 126). MAIN OUTCOME MEASURE The distal outcome of TD was categorized as 30 days or less and more than 30 days from diagnosis to surgical treatment. RESULTS Our LCA identified a 4-class solution and a 3-class solution for in situ and malignant profiles, respectively. The highest in situ CRC patient risk profile was female, White, aged 75 to 84 years, widowed, and used public health insurance when compared with respective profiles. The highest malignant CRC patient risk profile was male, Black, both single/never married and divorced/separated, resided in non-Appalachian county, and used public health insurance when compared with respective profiles. The highest risk profiles of in situ and malignant patients had a TD likelihood of 19.3% and 29.4%, respectively. CONCLUSIONS While our findings are not meant for diagnostic purposes, we found that Blacks had lower TD with in situ CRC. The opposite was found in the malignant profiles where Blacks had the highest TD. Although TD is not a definitive marker of survival, we observed that non-Appalachian underserved/underrepresented groups were overrepresented in the highest TD profiles. The observed disparities could be indicative of intervenable risk.
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Affiliation(s)
- Francisco A. Montiel Ishino
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland (Drs Montiel Ishino and William and Mr Villalobos); Department of Environmental Health Sciences, University of Alabama at Birmingham, Birmingham, Alabama (Dr Odame); Tennessee Cancer Registry, Tennessee Department of Health, Nashville, Tennessee (Dr Whiteside); and Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee (Dr Mamudu)
| | - Emmanuel A. Odame
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland (Drs Montiel Ishino and William and Mr Villalobos); Department of Environmental Health Sciences, University of Alabama at Birmingham, Birmingham, Alabama (Dr Odame); Tennessee Cancer Registry, Tennessee Department of Health, Nashville, Tennessee (Dr Whiteside); and Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee (Dr Mamudu)
| | - Kevin Villalobos
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland (Drs Montiel Ishino and William and Mr Villalobos); Department of Environmental Health Sciences, University of Alabama at Birmingham, Birmingham, Alabama (Dr Odame); Tennessee Cancer Registry, Tennessee Department of Health, Nashville, Tennessee (Dr Whiteside); and Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee (Dr Mamudu)
| | - Martin Whiteside
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland (Drs Montiel Ishino and William and Mr Villalobos); Department of Environmental Health Sciences, University of Alabama at Birmingham, Birmingham, Alabama (Dr Odame); Tennessee Cancer Registry, Tennessee Department of Health, Nashville, Tennessee (Dr Whiteside); and Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee (Dr Mamudu)
| | - Hadii Mamudu
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland (Drs Montiel Ishino and William and Mr Villalobos); Department of Environmental Health Sciences, University of Alabama at Birmingham, Birmingham, Alabama (Dr Odame); Tennessee Cancer Registry, Tennessee Department of Health, Nashville, Tennessee (Dr Whiteside); and Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee (Dr Mamudu)
| | - Faustine Williams
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland (Drs Montiel Ishino and William and Mr Villalobos); Department of Environmental Health Sciences, University of Alabama at Birmingham, Birmingham, Alabama (Dr Odame); Tennessee Cancer Registry, Tennessee Department of Health, Nashville, Tennessee (Dr Whiteside); and Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee (Dr Mamudu)
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Shively D, Makhani SS, Bouz A, Hernandez E, Chung-Bridges K. Racial Disparities in Survival Outcomes of Colorectal Cancer Patients After Surgical Resection. Cureus 2022; 14:e22064. [PMID: 35295347 PMCID: PMC8916922 DOI: 10.7759/cureus.22064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/11/2022] [Indexed: 11/05/2022] Open
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Sharma M, Aljuboori Z, Dietz N, Wang D, Ugiliweneza B, Williams B, Andaluz N. Incidence and Long-Term Health Care Utilization Associated With Pseudomeningocele Repair Following Vestibular Schwannoma Resection: A National Database Analysis. Cureus 2022; 14:e21248. [PMID: 35186536 PMCID: PMC8844231 DOI: 10.7759/cureus.21248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/14/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction To compare the healthcare utilization in patients who presented with no pseudomeningocele (PSM) following vestibular schwannoma (VS) surgery (nd-PSM), PSM following VS surgery and required surgical repair (s-PSM) and those who presented with PSM and did not require surgical repair (ns-PSM). Methods MarketScan database was queried using the International Classification of Diseases, ninth and tenth revisions, and current procedural terminology four, from 2000 to 2018. We included patients ≥18 years of age with a PSM diagnosis with at least two years of continuous enrollment. The hospital admissions, outpatient services, medication refills, and associated payments were analyzed. Results Of 1,460 patients, 96.6% (n=1,411) had no PSM following surgery for VS, 2.4% (n=35) were in s-PSM and only 0.95% (n=14) were in ns-PSM cohorts. Patients in the s-PSM cohort incurred higher hospital readmission rate, outpatient payments compared to those in the nd-PSM and ns-PSM cohorts at six months, one-year, and two-years following the following VS resection. At one-year following VS resection, the median combined payments for the s-PSM cohort were $74,683 compared to $42,664 for the ns-PSM and $9,476 for the nd-PSM cohort, p<0.0001. Similarly, at two-years, median combined payments for s-PSM cohort were $83,351 compared to $63,942 for ns-PSM and $18,839 for the nd-PSM cohort, p<0.0001. Conclusion Patients in the s-PSM cohort incurred eight times and 4.4 times the combined payments at one- and two-years, respectively, compared to the nd-PSM cohort. Also, patients in the ns-PSM cohort incurred 4.5 times and 3.4 times the payments compared to the nd-PSM cohort.
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Wu Y, Zhu PZ, Chen YQ, Chen J, Xu L, Zhang H. Relationship between marital status and survival in patients with lung adenocarcinoma: A SEER-based study. Medicine (Baltimore) 2022; 101:e28492. [PMID: 35029903 PMCID: PMC8735761 DOI: 10.1097/md.0000000000028492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/16/2021] [Indexed: 11/29/2022] Open
Abstract
Numerous studies have focused on whether the marital status has an impact on the prognosis in patients with non-small cell lung cancer, but none have focused on lung adenocarcinoma.We selected 61,928 eligible cases with lung adenocarcinoma from the Surveillance, Epidemiology, and End Results database from 2004 to 2016 and analyzed the impact of marital status on cancer-specific survival (CSS) using Kaplan-Meier and Cox regression analyses.We confirmed that sex, age, race, cancer TNM stage and grade, therapeutic schedule, household income, and marital status were independent prognostic factors for lung adenocarcinoma CSS. Multivariate Cox regression showed that widowed patients had worse CSS (hazard ratio 1.26, 95% confidence interval 1.20-1.31, P < .001) compared with married patients. Subgroup analysis showed consistent results regardless of sex, age, cancer grade, and TNM stage. However, the trend was not significant for patients with grade IV cancer.These results suggest that marital status is first identified as an independent prognostic factor for CSS in patients with lung adenocarcinoma, with a clear association between widowhood and a high risk of cancer-specific mortality. Psychological and social support are thus important for patients with lung adenocarcinoma, especially unmarried patients.
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Affiliation(s)
- Ying Wu
- Department of Oncology, the First People's Hospital of Yongkang City, Yongkang, Zhejiang Province, China
| | - Pei-Zhen Zhu
- Department of Oncology, the First People's Hospital of Yongkang City, Yongkang, Zhejiang Province, China
| | - Yin-Qiao Chen
- Department of Oncology, the First People's Hospital of Yongkang City, Yongkang, Zhejiang Province, China
| | - Jie Chen
- Department of Respiratory Medicine, the First People's Hospital of Yongkang City, Yongkang, Zhejiang Province, China
| | - Lu Xu
- Department of Oncology, the First People's Hospital of Yongkang City, Yongkang, Zhejiang Province, China
| | - Huayi Zhang
- Department of Oncology, the First People's Hospital of Yongkang City, Yongkang, Zhejiang Province, China
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Dietz N, Sharma M, Kelly M, Ugiliweneza B, Wang D, Osorio J, Karikari I, Drazin D, Boakye M. Recombinant Human Bone Morphogenetic Protein-2 Use in Adult Spinal Deformity Surgery: Comparative Analysis and Healthcare Utilization at 24 Months' Follow-up. Global Spine J 2022; 12:92-101. [PMID: 32844671 PMCID: PMC8965293 DOI: 10.1177/2192568220947377] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE Recombinant human bone morphogenetic protein-2 (rhBMP-2) is used to achieve fusion in adult spinal deformity (ASD) surgery. Our aim was to investigate the long-term impact of rhBMP-2 use for clinical outcomes and health care utilization in this patient population. METHODS We conducted an analysis using MarketScan to identify health resource utilization of rhBMP-2 use for ASD after surgical intervention compared to fusion without rhBMP-2 at 24 months' follow-up. Outcomes assessed included length of stay, complications, pseudoarthrosis, reoperation, outpatient services, and health care payments. RESULTS Of 7115 patients who underwent surgery for ASD, 854 received rhBMP-2 and 6261 were operated upon without use of rhBMP-2. One month after discharge, the rhBMP-2 cohort had a nonsignificant trend in fewer complications (15.38%) than those who did not receive rhBMP-2 (18.07%), P = .0558. At 12 months, pseudoarthrosis was reported in 2.8% of cases with no BMP and 01.14% of cases with BMP, P = .0048. Average payments at 12 months were $120 138 for the rhBMP-2 group and $118 373 for the no rhBMP-2 group, P = .8228. At 24 months, payments were $141 664 for the rhBMP-2 group and $144 179 for the group that did not receive rhBMP-2, P = .5946. CONCLUSIONS In ASD surgery, use of rhBMP-2 was not associated with increased complications or reoperations at index hospitalization and 1-month follow-up. Overall payments, including index hospitalization, readmissions, reoperations, and outpatient services were not different compared to those without the use of rhBMP-2 at 12 months and 24 months after discharge.
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Affiliation(s)
| | | | | | | | | | - Joseph Osorio
- University of California, San Diego, San Diego, CA, USA
| | | | - Doniel Drazin
- Pacific Northwest University of Health Sciences College of Medicine, Yakima, WA, USA
| | - Maxwell Boakye
- University of Louisville, Louisville, KY, USA,Maxwell Boakye, Department of Neurosurgery, School of Medicine, University of Louisville, 220 Abraham Flexner Way, Louisville, KY 40202, USA.
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Dietz N, Sharma M, John K, Wang D, Ugiliweneza B, Mokshagundam S, Bjurström MF, Boakye M, Williams BJ, Andaluz N. 90-Day Bundled Payment Simulation, Health Care Utilization, and Complications following Craniopharyngioma Resection in Adult Patients. J Neurol Surg B Skull Base 2021; 83:515-525. [DOI: 10.1055/s-0041-1740395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 11/05/2021] [Indexed: 10/19/2022] Open
Abstract
Abstract
Context Bundled payment and health care utilization models inform cost optimization and surgical outcomes. Economic analysis of payment plans for craniopharyngioma resection is unknown.
Objective This study aimed to identify impact of endocrine and nonendocrine complications (EC and NEC, respectively) on health care utilization and bundled payments following craniopharyngioma resection.
Design This study is presented as a retrospective cohort analysis (2000–2016) with 2 years of follow-up.
Setting The study included national inpatient hospitalization and outpatient visits.
Patients Patients undergoing craniopharyngioma resection were divided into the following four groups: group 1, no complications (NC); group 2, only EC; group 3, NEC; and group 4, both endocrine and nonendocrine complications (ENEC).
Interventions This study investigated transphenoidal or subfrontal approach for tumor resection.
Main Outcome Hospital readmission, health care utilization up to 24 months following discharge, and 90-day bundled payment performances are primary outcomes of this study.
Results Median index hospitalization payments were significantly lower for patients in NC cohort ($28,672) compared with those in EC ($32,847), NEC ($36,259), and ENEC ($32,596; p < 0.0001). Patients in ENEC incurred higher outpatient services and overall median payments at 6 months (NC: 38,268; EC: 49,844; NEC: 68,237; and ENEC: 81,053), 1 year (NC: 46,878; EC: 58,210; NEC: 81,043; and ENEC: 94,768), and 2 years (NC: 58,391; EC: 70,418; NEC: 98,838; and ENEC: 1,11,841; p < 0.0001). The 90-day median bundled payment was significantly different among the cohorts with the highest in ENEC ($60,728) and lowest in the NC ($33,089; p < 0.0001).
Conclusion ENEC following surgery incurred almost two times the overall median payments at 90 days, 6 months, 1 year. and 2 years compared with those without complications. Bundled payment model may not be a feasible option in this patient population. Type of complications and readmission rates should be considered to optimize payment model prediction following craniopharyngioma resection.
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Affiliation(s)
- Nicholas Dietz
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
| | - Mayur Sharma
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
| | - Kevin John
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
| | - Dengzhi Wang
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
| | - Beatrice Ugiliweneza
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
| | | | - Martin F. Bjurström
- Department of Anesthesiology and Intensive Care, Skane University Hospital, Lund Sweden
| | - Maxwell Boakye
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
| | - Brian J. Williams
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
| | - Norberto Andaluz
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
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Kamath SD, Torrejon N, Wei W, Tullio K, Nair KG, Liska D, Krishnamurthi SS, Khorana AA. Racial disparities negatively impact outcomes in early-onset colorectal cancer independent of socioeconomic status. Cancer Med 2021; 10:7542-7550. [PMID: 34647438 PMCID: PMC8559495 DOI: 10.1002/cam4.4276] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/18/2021] [Accepted: 08/24/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The incidence of colorectal cancer (CRC) in patients under age 50 is rising for unclear reasons. We examined the effects of socioeconomic factors on outcomes for patients with early-onset CRC compared to late-onset CRC. METHODS Patients with CRC from 2004 to 2015 in the National Cancer Database were included and categorized by age (under or over 50 years). Differences in demographic and socioeconomic factors, disease characteristics, and survival outcomes between early-onset versus late-onset CRC patients were assessed by Chi-squared test and Cox models. RESULTS The study population included 1,061,204 patients, 108,058 (10.2%) of whom were under age 50. The proportion of patients diagnosed under age 50 increased over time: 9.4% in 2004-2006, 10.1% in 2007-2009, 10.5% in 2010-2012, and 10.7% in 2013-2015 (p < 0.0001). Early-onset CRC patients were more likely to be Black (15.1% vs. 11.3%) or Hispanic (8.6% vs. 4.6%) and to present with stage 4 disease (24.9% vs. 17.0%), p < 0.0001 for all. Black patients had the worst median OS (58.3 months) compared to White (67.0 months), Hispanic (91.6 months), or Asian (104.9 months) patients, p < 0.0001. Within the subgroup of early-onset CRC patients with private insurance, Black patients had worse OS compared to White patients, even in communities with higher income and education status. CONCLUSIONS Early-onset CRC continues to increase. Patients with early-onset CRC are more likely to be Black or Hispanic and to present with stage 4 cancer. Early-onset Black patients showed worse OS compared to White patients in all income subgroups, even with private insurance.
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Affiliation(s)
- Suneel D. Kamath
- Cleveland Clinic Lerner College of MedicineCleveland Clinic Taussig Cancer InstituteClevelandOhioUSA
| | - Nataly Torrejon
- Department of Internal MedicineCleveland Clinic FoundationClevelandOhioUSA
| | - Wei Wei
- Department of Quantitative Health SciencesCleveland ClinicClevelandOhioUSA
| | - Katherine Tullio
- Cleveland Clinic Lerner College of MedicineCleveland Clinic Taussig Cancer InstituteClevelandOhioUSA
| | - Kanika G. Nair
- Cleveland Clinic Lerner College of MedicineCleveland Clinic Taussig Cancer InstituteClevelandOhioUSA
| | - David Liska
- Department of Internal MedicineCleveland Clinic FoundationClevelandOhioUSA
| | - Smitha S. Krishnamurthi
- Cleveland Clinic Lerner College of MedicineCleveland Clinic Taussig Cancer InstituteClevelandOhioUSA
| | - Alok A. Khorana
- Cleveland Clinic Lerner College of MedicineCleveland Clinic Taussig Cancer InstituteClevelandOhioUSA
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Hanna DN, Ghani MO, Hermina A, Mina A, Bailey CE, Idrees K, Magge D. Impact of Insurance Status on Oncologic and Perioperative Outcomes After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 2021; 29:253-259. [PMID: 34432192 DOI: 10.1245/s10434-021-10670-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/04/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND A growing body of research has shown that underinsured patients are at increased risk of worse health outcomes compared with insured patients. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is largely performed at highly specialized cancer centers and may pose challenges for the underinsured. This study investigates surgical outcomes following CRS-HIPEC for insured and underinsured patients with peritoneal carcinomatosis. METHODS We performed a retrospective cohort study of 125 patients undergoing CRS-HIPEC between 2013 and 2019. Patients were categorized into two groups. The insured group was comprised of patients with private insurance at the time of CRS-HIPEC or who obtained it during the follow-up period. The underinsured group consisted of patients with Medicaid, or self-pay. Perioperative and oncologic outcomes were compared between the two groups. RESULTS A total of 102 (82.3%) patients were insured, and 22 (17.7%) patients were underinsured. There were no significant differences in age, medical morbidities, primary tumor characteristics, peritoneal carcinomatosis index, or completion of cytoreduction score between the two groups. The median overall survival (OS) for insured patients was 64.8 months and was 52.9 months for underinsured patients (p = 0.01). Additionally, insured patients had a significantly longer follow-up time. Underinsurance status also was associated with increased hospital and intensive care unit length of stay, and higher rate of Clavien-Dindo classification III-IV complications. CONCLUSIONS In this retrospective study conducted at a large, urban, specialized cancer center, private insurance status was associated with increased overall survival and longer follow-up period. Furthermore, underinsurance status was associated with increased perioperative morbidity.
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Affiliation(s)
- David N Hanna
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Muhammad O Ghani
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Alexander Mina
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Christina E Bailey
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kamran Idrees
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Deepa Magge
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
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Shi L, Suh W, Kavanaugh MM, Mills G, Thayer S, Shi R. Propensity Score Matching Analysis of the Effect of Payer Status on the Survival of Colon Cancer Patients. Cureus 2021; 13:e15748. [PMID: 34285854 PMCID: PMC8286796 DOI: 10.7759/cureus.15748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 11/05/2022] Open
Abstract
Background and objective Colon cancer is one of the most common types of cancer globally. The factors that could affect colon cancer survival include age, stage, treatment, and other socioeconomic aspects. Payer status has been shown to be a significant predictor of cancer patient survival in retrospective studies. However, due to the limitations of retrospective studies, patient baseline characteristics between payer statuses are not comparable. Few studies have addressed the effect of payer status on the overall survival (OS) of patients using propensity score matching (PSM). In light of this, we conducted a study to examine the effect of payer status on the survival of colon cancer patients based on PSM. Materials and methods About 66,493 stage II/III colon cancer patients aged 40-90 years and diagnosed between 2004 and 2015 were analyzed from a de-identified National Cancer Database (NCDB) file. All patients had undergone surgery, and patients who had received radiation therapy, hormone therapy, immunotherapy, palliative care, or therapies other than chemotherapy were excluded. Only private or Medicaid payer status was included. The propensity score was calculated by computing the probability of patients being in the Medicaid group using logistic regression. The PSMATCH procedure in the SAS software (SAS Inc., Gary, NC) was used to perform PSM on patients with Medicaid and private insurance. The greedy nearest neighbor matching method was used to match one Medicaid to one privately insured patient with a caliper of 0.2. At the same time, an exact match was done for gender, age group, race, and stage at diagnosis. Multivariate Cox regression was then used to estimate the effect of payer status on survival before and after PSM. Results Among the 66,493 patients, 90.3% were privately insured and 9.7% had Medicaid. In univariate analysis, payer status was found to be a significant predictor of OS. Prior to PSM, the median overall survival (MOS) for patients with private insurance was 12.75 years, while those with Medicaid had a MOS of 9.02 years. After PSM, 6,167 paired patients were matched, and patients with private insurance had a MOS of >12.82 years and Medicaid patients had a MOS of 8.88 years. After PSM, patients with Medicaid had a 50% increased risk of death, and payer status proved to be a statistically significant predictor of OS of colon cancer. Conclusion Based on our findings, as per the PSM method, payer status can be a significant predictor of survival among colon cancer patients. Also, chemotherapy, race, age, and other socioeconomic factors were also found to be significant predictors of OS. Further research should be conducted to investigate other covariates not studied here and the mediation effect of payer on the survival of cancer patients.
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Affiliation(s)
- Lawrence Shi
- Hematology-Oncology, Tulane University, New Orleans, USA
| | - Winston Suh
- Hematology-Oncology, Department of Medicine & Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, USA
| | - Mindie M Kavanaugh
- Hematology-Oncology, Department of Medicine & Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, USA
| | - Glenn Mills
- Hematology-Oncology, Department of Medicine & Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, USA
| | - Sarah Thayer
- Surgical Oncology, Department of Medicine & Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, USA
| | - Runhua Shi
- Hematology-Oncology, Department of Medicine & Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, USA
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21
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Cho DY, Park J, Kim DS. The impact of expanding health insurance coverage for anti-cancer drugs on cancer survival in Korea. Cancer Med 2021; 10:4555-4563. [PMID: 34145980 PMCID: PMC8267115 DOI: 10.1002/cam4.3979] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 03/31/2021] [Accepted: 05/03/2021] [Indexed: 01/10/2023] Open
Abstract
Background To reduce out‐of‐pocket costs, the Korean government expanded health insurance reimbursement in anti‐cancer drugs for cancer patients in 2013. Our objective was to examine the impact of the benefit coverage expansion policy on healthcare utilization and overall survival (OS) among patients with six types of solid cancer after the policy of expanding health insurance coverage. Methods This study analyzed a before‐and‐after retrospective cohort of patients newly diagnosed with six types of solid cancer (stomach cancer, colorectal cancer, lung cancer, liver cancer, breast cancer, and prostate cancer) from January 1, 2009 to December 31, 2015 in Korea. The intervention was the expansion of reimbursement in 2013. Multivariate Cox proportional hazards regression was used to estimate the policy effect. Results In total, 142,579 before and 147,760 patients after the benefit expansion, and after matched by age, gender, and stage, 132,440 before and 132,440 patients after policy were included in the analysis. Almost total medical expenditure increased for five types of cancer increased. The expansion of health insurance reimbursement was associated with significantly lower overall mortality compared with pre‐policy mortality for all six cancer sites. Conclusion The policy of expanding health insurance reimbursement might have been associated with a significant increase in survival among cancer patients by ensuring access to health care and medicine. Although the reimbursement expansion timing differs for each cancer, it is believed that eliminating delayed treatment might rather lead to reduce medical expenses and improve health outcomes.
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Affiliation(s)
- Do-Yeon Cho
- Department of Research, Health Insurance Review & Assessment Service, Wonju, South Korea
| | - Juhee Park
- Department of Research, Health Insurance Review & Assessment Service, Wonju, South Korea
| | - Dong-Sook Kim
- Department of Research, Health Insurance Review & Assessment Service, Wonju, South Korea
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Akinkuotu AC, Maduekwe UN, Hayes-Jordan A. Surgical outcomes and survival rates of colon cancer in children and young adults. Am J Surg 2021; 221:718-724. [PMID: 33678398 DOI: 10.1016/j.amjsurg.2021.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Colon cancer in children and young adults is rare. We sought to compare outcomes and survival between patients ≤and>25 years of age with colon cancer. METHODS Using the National Cancer Database, patients with colon cancer between 2004 and 2016 were identified. We included patients with histological codes consistent with invasive colon adenocarcinoma and excluded those missing data about treatment. Post-surgical outcomes and survival were compared. RESULTS Of 531,462 patients meeting criteria, 947 were ≤25 years. Patients ≤25 had more advanced disease (stage III:44.4%vs33.4%, stage IV:27.5%vs.15.3%) and higher rates of total colectomy (8.9%vs.2.7%) and proctocolectomy (5.0%vs.0.0%) than those >25 years. Stage for stage, 5-year survival was higher in patients ≤25 than those >25years. On multivariate regression, age was not associated with increased risk of mortality while male sex and uninsured status were. CONCLUSIONS Despite presenting with more advanced disease, patients ≤25 years with colon cancer had better survival than those >25 years.
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Affiliation(s)
- Adesola C Akinkuotu
- Division of Pediatric Surgery, Department of Surgery, University of North Carolina Chapel Hill, Chapel Hill, NC, USA.
| | - Ugwuji N Maduekwe
- Division of Surgical Oncology & Endocrine Surgery, Department of Surgery, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Andrea Hayes-Jordan
- Division of Pediatric Surgery, Department of Surgery, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
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Snyder RA, Wardrop R, McLain AC, Parikh AA, Cass AL. Association of Patient Experience With Guideline-Concordant Colon Cancer Treatment in the Elderly. JCO Oncol Pract 2021; 17:e753-e763. [PMID: 33566681 DOI: 10.1200/op.20.00626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE The association between patient-reported experience of care and care quality is not well described. The purpose of this study was to assess the relationship between the patient-reported experience and receipt of guideline-concordant colon cancer (CC) treatment. METHODS Medicare beneficiaries with resected stage I-III CC (2003-2013) were identified in the linked SEER Consumer Assessment of Healthcare Providers and Systems data set. Patient-reported scores were compared by receipt of guideline concordant care (GCC) (resection of ≥ 12 lymph nodes [stage I-III] and adjuvant chemotherapy [stage III]). Linear mixed-effects regression was performed to compare adjusted mean patient experience scores by GCC. RESULTS Of the 1,010 identified patients, 58.4% of stage I (n = 192/329) and 73.4% of stage II (n = 298/406) patients underwent resection of ≥ 12 LN. Among stage III patients, 76.0% (n = 209/275) underwent resection of ≥ 12 lymph node and 52.4% (n = 144/275) received adjuvant chemotherapy. By multivariable analysis, patient-reported scores of healthcare quality, physicians, physician communication, getting needed care, and getting care quickly were similar among patients who received GCC compared with those who did not. However, mean scores of overall healthcare quality (91.3 v 82.4, P = .0004) and getting needed care (92.8 v 86.8, P = .047) were higher among stage III patients who received GCC compared with those who did not. CONCLUSION Patient-reported scores of healthcare quality and ability to get needed care are associated with GCC among elderly patients with stage III CC. Further investigation is needed to determine whether patient-reported experience correlates with other clinical measures of quality of CC care.
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Affiliation(s)
- Rebecca A Snyder
- Department of Surgery, University of South Carolina School of Medicine - Greenville/Prisma Health, Greenville, SC.,Now with the Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC.,Now with the Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Rebecca Wardrop
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Alexander C McLain
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Alexander A Parikh
- Department of Surgery, University of South Carolina School of Medicine - Greenville/Prisma Health, Greenville, SC.,Now with the Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Anna L Cass
- Department of Health Sciences, Furman University, Greenville, SC
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Dietz N, Sharma M, Alhourani A, Ugiliweneza B, Nuno M, Drazin D, Wang D, Boakye M. Preoperative and Postoperative Opioid Dependence in Patients Undergoing Anterior Cervical Diskectomy and Fusion for Degenerative Spinal Disorders. J Neurol Surg A Cent Eur Neurosurg 2021; 82:232-240. [PMID: 33540452 DOI: 10.1055/s-0040-1718759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Anterior cervical diskectomy and fusion (ACDF) is a procedure for effectively relieving radiculopathy. Opioids are commonly overprescribed in postsurgical settings and prescriptions vary widely among providers. We identify trends in opioid dependence before and after ACDF. METHODS We used the Truven Health MarketScan data to identify adult patients undergoing ACDF for degenerative cervical spine conditions between 2009 and 2015. Patients were segregated in four cohorts of preoperative and postoperative opioid nondependence (ND) or dependence (D) with 15 months of postoperative follow-up. RESULTS A total of 25,403 patients with median age of 52 years (18-92) who underwent ACDF met the inclusion criteria. Breakdown of the four cohorts was as follows: prior nondependent who remain nondependent (NDND): 62.76% (n = 15,944); prior nondependent who become dependent (NDD): 4.6% (n = 1,168); prior dependent who become nondependent (DND): 14.03% (n = 3,564); and prior dependent who remain dependent (DD): 18.61% (n = 4,727). Opioid dependence decreased 9.43% postoperatively. Overall payments and 30-day readmissions increased 1.96 and 1.79 times for opioid dependent versus nondependent cohorts, respectively. Adjusted payments at 3 to 15 months were significantly increased for dependent cohorts with 3.56-fold increase for the DD cohort when compared with the NDND cohort. Length of stay, complications, medication refills, outpatient measures, and hospital admissions were also higher in those groups with postoperative opioid dependence when compared with those who were not opioid dependent. CONCLUSIONS Opioid dependence after ACDF is associated with increased hospital readmissions, complication rates at 30 days, and payments within 3 months and 3 to 15 months postdischarge. Overall opioid dependence was decreased after ACDF procedure, however, a smaller number of opioid-dependent and opioid-naive patients became dependent postoperatively and should be followed carefully.
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Affiliation(s)
- Nicholas Dietz
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, United States
| | - Mayur Sharma
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, United States
| | - Ahmad Alhourani
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, United States
| | - Beatrice Ugiliweneza
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, United States
| | - Miriam Nuno
- Department of Neurosurgery, University of California Davis, Davis, California, United States
| | - Doniel Drazin
- Department of Neurosurgery, Pacific Northwest University of Health Sciences, Yakima, Washington, United States
| | - Dengzhi Wang
- Department of Neurosurgery, University of California Davis, Davis, California, United States
| | - Maxwell Boakye
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, United States.,Department of Neurosurgery, Robley Rex VA Medical Center, Louisville, Kentucky, United States
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Brooks ES, Tong J, Mavroudis CW, Wirtalla C, Karakousis GC, Saur NM, Aarons CB, Mahmoud NN, Kelz RR. The effects of the Affordable Care Act on access and outcomes of colon surgery. Am J Surg 2021; 222:613-618. [PMID: 33487402 DOI: 10.1016/j.amjsurg.2021.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/03/2021] [Accepted: 01/11/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Insurance status has been strongly associated with both access to and outcomes of colon resection (CRS). Under the Affordable Care Act (ACA), individual states opted to participate in Medicaid expansion (ME) and adopt essential health benefits (EHB). METHODS We performed a quasi-experimental difference-in-differences (DID) analysis of 2012-2017 state-level inpatient claims with risk adjustment. We examined frequency of emergent presentation and in-hospital death. Subset analyses were performed by insurance type. RESULTS Among the 73,961 CRS patients, 49.6% were in a state with both ME and EHB, 34.7% presented emergently, and 2.0% died. Adoption of ME and EHB was associated with a significant, 24%, reduction in the likelihood of in-hospital mortality, and no significant change in emergent presentation for CRS. CONCLUSIONS The ACA's ME was strongly associated with a decrease in mortality following colon resection among Medicaid beneficiaries. These findings support the adoption of healthcare policies that improve access to insurance.
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Affiliation(s)
- Ezra S Brooks
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.
| | - Jason Tong
- University of Pennsylvania, Center for Surgery and Health Economics, Department of Surgery, Philadelphia, PA, USA
| | - Catherine W Mavroudis
- University of Pennsylvania, Center for Surgery and Health Economics, Department of Surgery, Philadelphia, PA, USA
| | - Christopher Wirtalla
- University of Pennsylvania, Center for Surgery and Health Economics, Department of Surgery, Philadelphia, PA, USA
| | - Giorgos C Karakousis
- University of Pennsylvania, Center for Surgery and Health Economics, Department of Surgery, Philadelphia, PA, USA
| | - Nicole M Saur
- University of Pennsylvania, Department of Surgery, Philadelphia, PA, USA
| | - Cary B Aarons
- University of Pennsylvania, Department of Surgery, Philadelphia, PA, USA
| | - Najjia N Mahmoud
- University of Pennsylvania, Center for Surgery and Health Economics, Department of Surgery, Philadelphia, PA, USA
| | - Rachel R Kelz
- University of Pennsylvania, Center for Surgery and Health Economics, Department of Surgery, Philadelphia, PA, USA
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Pryor KP, Barbhaiya M, Costenbader KH, Feldman CH. Disparities in Lupus and Lupus Nephritis Care and Outcomes Among US Medicaid Beneficiaries. Rheum Dis Clin North Am 2021; 47:41-53. [PMID: 34042053 DOI: 10.1016/j.rdc.2020.09.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Systemic lupus erythematosus (SLE) is a serious chronic autoimmune disease with substantial morbidity and mortality. Although improved diagnostics and therapeutics have contributed to declining mortality rates, important disparities exist in SLE survival rates by race, ethnicity, gender, age, country, and social disadvantage. This review highlights the burden of SLE and lupus nephritis among Medicaid beneficiaries, outlines barriers in access to high-quality SLE care and medication adherence in the Medicaid SLE population, and summarizes disparities in adverse outcomes among SLE patients enrolled in Medicaid.
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Dietz N, Sharma M, Ugiliweneza B, Wang D, Boakye M, Williams B, Andaluz N. Health Care Utilization in Patients Undergoing Repeat Stereotactic Radiosurgery for Vestibular Schwannoma with 5-Year Follow-up: A National Database Analysis. J Neurol Surg B Skull Base 2020; 83:19-27. [DOI: 10.1055/s-0040-1716672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 08/03/2020] [Indexed: 10/23/2022] Open
Abstract
Abstract
Background Stereotactic radiosurgery (SRS) has been used as an alternative to microsurgery in patients with small vestibular schwannoma (VS). We compare health care utilization metrics in patients undergoing repeat-SRS (re-SRS) and no repeat SRS (nr-SRS) at long-term follow-up.
Materials and Methods We queried the MarketScan database using International Classification of Diseases, Ninth Revision and Current Procedural Terminology 4, from 2000 to 2016. We included adult patients who had diagnosis of VS and treatment with SRS with at least 5 years of continuous enrollment after the procedure. Outcomes were hospital admissions, outpatient services, and medication refills.
Results Of 1,047 patients, 5.1% (n = 53) had repeat SRS. Majority of re-SRS (74%, n = 39) were done within 2 years of index procedure and 51% were within 1-year of initial procedure. Patients who required re-SRS incurred higher hospital readmission rate, outpatient services, and had higher payments compared with those who did not require re-SRS at 6 months, 1 year, and 2 years following the initial procedures. Re-SRS received 3.0- and 3.1-times higher payments at 1 and 2 years compared with nr-SRS cohort. At 5 years following SRS, median combined payments for re-SRS cohort was $105286 (interquartile range [IQR] $70999, $156569) compared with $44172 (IQR $22956, $84840) for nr-SRS cohort.
Conclusion More than half of the re-SRS procedures were noted within first year of initial SRS for VS. Overall payments at 5 years for repeat SRS was more than double that for nr-SRS. Repeat SRS was also associated with more re-admissions and outpatient services at annual follow-up time points.
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Affiliation(s)
- Nicholas Dietz
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
| | - Mayur Sharma
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
| | - Beatrice Ugiliweneza
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
| | - Dengzhi Wang
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
| | - Maxwell Boakye
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
| | - Brian Williams
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
| | - Norberto Andaluz
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
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Aljuboori Z, Ugiliweneza B, Wang D, Andaluz N, Boakye M, Williams B. Economics of the Management of Craniospinal Chordoma and Chondrosarcoma and the feasibility of the bundled payment model. BMC Neurol 2020; 20:312. [PMID: 32825828 PMCID: PMC7441625 DOI: 10.1186/s12883-020-01850-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 06/29/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The Centers for Medicare and Medicaid Services (CMS) created a new reimbursement model "Bundled Payment for Care Improvement (BPCI)" which reimburses providers a predetermined payment in advance to cover all possible services rendered within a certain time window. Chordoma and Chondrosarcoma are locally aggressive malignant primary bony tumors. Treatment includes surgical resection and radiotherapy with substantial risk for recurrence which necessitates monitoring and further treatment. We assessed the feasibility of the BPCI model in these neurosurgical diseases. METHODS We selected patients with chordoma/chondrosarcoma from inpatient admission table using the International Classification of Disease, 9th (ICD-9), and 10th (ICD-10) revision codes. We collected the patients' demographics and insurance type at the index hospitalization. We recorded the following outcomes length of stay, total payment, discharge disposition, and complications for the index hospitalization. For post-discharge, we collected the 30 days and 3/6/12 months inpatient admission, outpatient service, and medication refills. Continuous variables were summarized by means with standard deviations, median with interquartile and full ranges (minimum-maximum); Continuous outcomes were compared by nonparametric Wilcoxson rank-sum test. All tests were 2-sided with a significance level of 0.05. Statistical data analysis was performed in SAS 9.4 (SAS Institute, Inc, Cary, NC). RESULTS The population size was 2041 patients which included 1412 patients with cranial (group1), 343 patients with a mobile spine (group 2), and 286 patients with sacrococcygeal (group 3) chordoma and chondrosarcoma. For index hospitalization, the median length of stay (days) was 4, 6, and 7 for groups 1, 2, and 3 respectively (P<.001). The mean payments were ($58,130), ($84,854), and ($82,440), for groups 1, 2, and 3 respectively (P=.02). The complication rates were 30%, 35%, and 43% for groups 1, 2, and 3 respectively (P<.001). Twelve months post-discharge, the hospital readmission rates were 44%, 53%, and 65% for groups 1, 2, and 3, respectively (P<.001). The median payments for this period were ($72,294), ($76,827), and ($101,474), for groups 1, 2, and 3, respectively (P <.001). CONCLUSION The management of craniospinal chordoma and chondrosarcoma is costly and may extend over a prolonged period. The success of BPCI requires a joint effort between insurers and hospitals. Also, it should consider patients' comorbidities, the complexity of the disease. Finally, the adoptionof quality improvement programs by hospitals can help with cost reduction.
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Affiliation(s)
- Zaid Aljuboori
- Department of Neurological Surgery, University of Louisville School of Medicine, 220 Abraham Flexner way, Ste.1500, Louisville, KY, 40202, USA.
| | - Beatrice Ugiliweneza
- Department of Neurological Surgery, University of Louisville School of Medicine, 220 Abraham Flexner way, Ste.1500, Louisville, KY, 40202, USA
| | - Dengzhi Wang
- Department of Neurological Surgery, University of Louisville School of Medicine, 220 Abraham Flexner way, Ste.1500, Louisville, KY, 40202, USA
| | - Norberto Andaluz
- Department of Neurological Surgery, University of Louisville School of Medicine, 220 Abraham Flexner way, Ste.1500, Louisville, KY, 40202, USA
| | - Maxwell Boakye
- Department of Neurological Surgery, University of Louisville School of Medicine, 220 Abraham Flexner way, Ste.1500, Louisville, KY, 40202, USA
| | - Brian Williams
- Department of Neurological Surgery, University of Louisville School of Medicine, 220 Abraham Flexner way, Ste.1500, Louisville, KY, 40202, USA
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Abstract
Background The impact of insurance status on renal cell carcinoma (RCC) patient survival is unclear. In this study, we investigated the effects of insurance status on the survival outcomes of RCC patients in the United States of America. Methods Data of patients diagnosed with RCC between 2007 and 2014 were obtained from the Surveillance, Epidemiology and End Results (SEER) database, a large national database including statistics on cancer patients. The Kaplan-Meier method and Cox regression analysis were used to determine the influence of insurance status on cancer-specific survival (CSS). Results A total of 30,951 eligible RCC patients were identified. Of these patients, 25,493 (82.37%) were insured, 3,959 (12.79%) had any Medicaid coverage, and 1,499 (4.84%) were uninsured. Kaplan-Meier analysis revealed that insurance status was associated with better CCS (P<0.001). The 5-year CSS rates of patients with insurance, any Medicaid, and no insurance were 88.3%, 82.6%, and 82.7%, respectively. Multivariate Cox regression analysis showed that patients with any Medicaid had poorer CSS than insured patients [hazard ratio (HR), 1.222; 95% confidence interval (CI), 1.100–1.357]. Stratified analysis revealed that at localized tumor stage and at regional tumor stage or among white patients, any Medicaid insurance was an independent predictor of an unfavorable survival outcome. Conclusions Among the RCC patients in this study, individuals with insurance experienced improved CSS while individuals with any Medicaid tended to suffer worse survival outcomes.
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Affiliation(s)
- Yan Li
- Department of Anesthesiology, the Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ming-Xi Zhu
- Department of Anatomy, School of Basic Medicine and Life Science, Hainan Medical University, Haikou, China
| | - Bing Zhang
- Department of Anesthesiology, the Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
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Patel KS, Alhatem A, Gadde U, Ahlawat S, Lambert C, Schwartz RA, Dalla Piazza M. Insurance status and level of education predict disparities in receipt of treatment and survival for anal squamous cell carcinoma. Cancer Epidemiol 2020; 67:101723. [PMID: 32408241 DOI: 10.1016/j.canep.2020.101723] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 04/06/2020] [Accepted: 04/11/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Anal squamous cell carcinoma (ASCC) is relatively rare, but its incidence and mortality have been steadily climbing in marginalized populations. We explored the impact of insurance status, education, and income on survival and receipt of chemoradiation therapy. METHODS We included patients with ASCC from the Surveillance, Epidemiology, and End Results Program database from 2004 to 2016. Socioeconomic variables included insurance status, level of education, income, and unemployment rate. Cox proportional hazards and multivariate logistic regression were used to determine predictors of survival and receipt of chemoradiation. RESULTS We included a total of 10,868 cases of ASCC. The median age was 55, 10.4 % were black, and 65.4 % were female. Overall, 74.1 % of patients received combination chemoradiation. In multivariate analysis, poorer survival was found for Medicaid (HR 1.52, 95 % CI 1.34-1.74) and uninsured (HR 1.68, 95 % CI 1.35-2.10) patients, and for communities with the lowest rates of high school education (HR 1.17, 95 % CI 1.02-1.38), lowest income (HR 1.29, 95 % CI 1.08-1.54), and highest unemployment (HR 1.21, 95 % CI 1.03-1.40). Patients were less likely to receive combination treatment if they were black (OR 0.76, 95 % CI 0.55-0.92), had Medicaid insurance (OR 0.54, 95 % CI 0.33-0.88) or lower education (OR 0.59, 95 % CI 0.46-0.76). CONCLUSION Insurance status, level of education, income, and employment impact survival and receipt of treatment in patients with ASCC. Identifying high risk patients and developing targeted interventions to improve access to treatment is integral to reducing these disparities and improving cancer survival.
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Ellis RJ, Schlick CJR, Feinglass J, Mulcahy MF, Benson AB, Kircher SM, Yang TD, Odell DD, Bilimoria K, Merkow RP. Failure to administer recommended chemotherapy: acceptable variation or cancer care quality blind spot? BMJ Qual Saf 2020; 29:103-112. [PMID: 31366576 PMCID: PMC7382916 DOI: 10.1136/bmjqs-2019-009742] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/02/2019] [Accepted: 07/09/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Chemotherapy quality measures consider hospitals compliant when chemotherapy is recommended, even if it is not received. This may mask shortcomings in cancer care delivery. Objectives of this study were to (1) identify patient factors associated with failure to receive recommended chemotherapy without a documented contraindication and (2) assess hospital variation in failure to administer recommended chemotherapy. METHODS Patients from 2005 to 2015 with breast, colon and lung cancers who failed to receive recommended chemotherapy were identified using the National Cancer Database. Hospital-level rates of failure to administer recommended chemotherapy were calculated, and patient and hospital factors associated with failure to receive recommended chemotherapy were identified by multivariable logistic regression. RESULTS A total of 183 148 patients at 1281 hospitals were analysed. Overall, 3.5% of patients with breast, 6.6% with colon and 10.7% with lung cancers failed to receive recommended chemotherapy. Patients were less likely to receive recommended chemotherapy in all cancers if uninsured or on Medicaid (p<0.05), as were non-Hispanic black patients with both breast and colon cancer (p<0.001). Significant hospital variation was observed, with hospital-level rates of failure to administer recommended chemotherapy as high as 21.8% in breast, 40.2% in colon and 40.0% in lung cancers. CONCLUSIONS AND RELEVANCE Though overall rates are low, failure to receive recommended chemotherapy is associated with sociodemographic factors. Hospital variation in failure to administer recommended chemotherapy is masked by current quality measure definitions and may define a significant and unmeasured difference in hospital quality.
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Affiliation(s)
- Ryan J Ellis
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois, USA
| | - Cary Jo R Schlick
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Joe Feinglass
- Division of General Internal Medicine and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mary F Mulcahy
- Robert H Lurie Comprehensive Cancer Center, Chicago, Illinois, USA
- Department of Medicine, Northwestern University Division of Hematology/Oncology, Chicago, Illinois, USA
| | - Al B Benson
- Robert H Lurie Comprehensive Cancer Center, Chicago, Illinois, USA
- Department of Medicine, Northwestern University Division of Hematology/Oncology, Chicago, Illinois, USA
| | - Sheetal M Kircher
- Robert H Lurie Comprehensive Cancer Center, Chicago, Illinois, USA
- Department of Medicine, Northwestern University Division of Hematology/Oncology, Chicago, Illinois, USA
| | - Tony D Yang
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Robert H Lurie Comprehensive Cancer Center, Chicago, Illinois, USA
| | - David D Odell
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Robert H Lurie Comprehensive Cancer Center, Chicago, Illinois, USA
| | - Karl Bilimoria
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois, USA
- Robert H Lurie Comprehensive Cancer Center, Chicago, Illinois, USA
| | - Ryan P Merkow
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois, USA
- Robert H Lurie Comprehensive Cancer Center, Chicago, Illinois, USA
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Cabo J, Shu X, Shu XO, Parikh A, Bailey C. Treatment at Academic Centers Decreases Insurance-Based Survival Disparities in Colon Cancer. J Surg Res 2020; 245:265-272. [DOI: 10.1016/j.jss.2019.07.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 06/19/2019] [Accepted: 07/18/2019] [Indexed: 12/20/2022]
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Jue JS, Koru-Sengul T, Miao F, Kroeger ZA, Moore KJ, Alameddine M, Punnen S, Parekh DJ, Ritch CR, Gonzalgo ML. Timing of adjuvant chemotherapy and overall survival following radical cystectomy. Urol Oncol 2019; 38:75.e15-75.e22. [PMID: 31864939 DOI: 10.1016/j.urolonc.2019.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 10/02/2019] [Accepted: 11/04/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND We investigated the relationship between timing of adjuvant chemotherapy on overall survival following radical cystectomy. METHODS We retrospectively reviewed the National Cancer Data Base for patients with newly diagnosed pT2-T4, N0, M0 urothelial cell carcinoma who received no treatment prior to radical cystectomy. Patients who received no adjuvant chemotherapy or who received adjuvant chemotherapy more than 45 days after radical cystectomy were propensity matched to patients receiving adjuvant chemotherapy within 45 days of radical cystectomy. Selection bias was assessed by comparing the length of stay, readmission rate, and surgical approach between groups. Median survival was calculated using Kaplan-Meier analysis. Adjusted hazard ratios and 95% confidence intervals were calculated from a multivariable Cox regression model to examine factors affecting overall survival. RESULTS From 2004 to 2014, 284 patients with muscle-invasive bladder cancer met inclusion criteria. Patients receiving chemotherapy within 45 days had the best 5-year overall survival (47.0%, 95%CI: 40.6%-53.2%) compared to those receiving chemotherapy after 45 days (37.5%, 95%CI: 31.4%-43.7%). Chemotherapy after 45 days and no adjuvant chemotherapy were significant predictors of worse overall survival compared to chemotherapy within 45 days (1.27, 1.02-1.59, P = 0.033 and 1.41, 1.12-1.78, P = 0.003). Receiving no adjuvant chemotherapy was not significantly different than chemotherapy after 45 days (1.11, 0.89-1.38, P = 0.348). Significant predictors of poorer overall survival were female sex (1.37, 1.04-1.81, P = 0.028), Medicare (1.37, 1.06-1.76, P = 0.016), pT3 stage (1.79, 1.35-2.38, P < 0.001), and pT4 stage (3.00, 2.20-4.01, P < 0.001). Significantly more patients with length of stay ≤7 days following RC received chemotherapy within 45 days (53.2%) compared to those who received adjuvant chemotherapy after 45 days after RC (44.0%) or no adjuvant chemotherapy (43.0%; P = 0.0369). CONCLUSIONS Initiation of adjuvant chemotherapy within 45 days of radical cystectomy for patients with pT2-4 bladder cancer was associated with an overall survival benefit compared to patients who received adjuvant chemotherapy after 45 days or no adjuvant chemotherapy.
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Affiliation(s)
- Joshua S Jue
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL.
| | - Tulay Koru-Sengul
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Feng Miao
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Zachary A Kroeger
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL
| | - Kevin J Moore
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Mahmoud Alameddine
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL
| | - Sanoj Punnen
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Dipen J Parekh
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Chad R Ritch
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Mark L Gonzalgo
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
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Ugiliweneza B, Guest J, Herrity A, Nuno M, Sharma M, Beswick J, Dietz N, Alhourani A, Wang D, Drazin D, Boakye M. A Two-decade Assessment of Changing Practice for Surgical Decompression and Fixation after Traumatic Spinal Cord Injury – Impact on Healthcare Utilization and Cost. Cureus 2019; 11:e6156. [PMID: 31890365 PMCID: PMC6913978 DOI: 10.7759/cureus.6156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Early surgery after traumatic spinal cord injury (TSCI) has been associated with a greater neurological recovery and reduced secondary complications. In this study, we aimed to evaluate the trend of early TSCI surgery (within 24 hours) over two decades and the effect on length of hospitalization, complications, and hospital charges. We extracted emergency admissions of adults diagnosed with TSCI from the National Inpatient Sample database (1998-2016). We analyzed the trend of early surgery and concurrent trends of complication rate, length of stay (LOS) and hospital charges. These outcomes were then compared between early and late surgery cohorts. There were 3942 (53%) TSCI patients who underwent early surgery, and 3446 (47%) were operated after 24 hours. The combined patient group characteristics consisted of median age 43 years (IQR: 29-59), 73% males, 72% white, 44% private payer, 18% Medicare, 17% Medicaid, 51% cervical, 30% thoracic, 75% from large hospitals, and 79% from teaching hospitals. The trend of early surgery, adjusted for annual case-mix, increased from 45% in 1998 to 64% in 2016. Each year was associated with 1.60% more patients undergoing early surgery than the previous year (p-value <0.05). During these years, the total LOS decreased, while hospital charges increased. Patients who underwent early surgery spent four fewer days in the hospital, accrued $28,705 lower in hospital charges and had 2.8% fewer complications than those with delay surgery. We found that the rate of early surgery has significantly increased from 1998 to 2016. However, as of 2016, one-third of patients still did not undergo spinal surgery within 24 hours. Late surgery is associated with higher complications, longer stays, and higher charges. The causes of delayed surgery are undoubtedly justified in some situations but require further delineation. Surgeons should consider performing surgery within 24 hours on patients with TSCI whenever feasible.
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Farrow NE, An SJ, Speicher PJ, Harpole DH, D'Amico TA, Klapper JA, Hartwig MG, Tong BC. Disparities in guideline-concordant treatment for node-positive, non-small cell lung cancer following surgery. J Thorac Cardiovasc Surg 2019; 160:261-271.e1. [PMID: 31924363 DOI: 10.1016/j.jtcvs.2019.10.102] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 10/03/2019] [Accepted: 10/19/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To examine guideline concordance across a national sample and determine the relationship between socioeconomic factors, use of recommended postoperative adjuvant therapy, and outcomes for patients with resected pN1 or pN2 non-small cell lung cancer. METHODS All margin-negative pT1-3 N1-2 M0 non-small cell lung cancers treated with lobectomy or pneumonectomy without induction therapy in the National Cancer Database between 2006 and 2013 were included. Use of guideline-concordant adjuvant treatment, defined as chemotherapy for pN1 disease and chemotherapy with or without radiation for pN2 disease, was examined. Multivariable regression models were developed to determine associations of clinical factors with guideline adherence. Survival was estimated using Kaplan-Meier and Cox proportional hazard analyses. RESULTS Of 13,462 patients, 10,113 had pN1 disease and 3349 had pN2 disease. Guideline-concordant adjuvant therapy was used in 6844 (67.7%) patients with pN1 disease and 2622 (78.3%) patients with pN2 disease. After multivariable adjustment, insurance status, older age, pneumonectomy, readmission, and longer postoperative stays were associated with lower likelihood of guideline concordance. Conversely, increased education level, later year of diagnosis, and greater nodal stage were associated with greater concordance. Overall, patients treated with guideline-concordant therapy had superior survival (5-year survival: 51.6 vs 36.0%; hazard ratio, 0.66; 95% confidence interval, 0.62-0.70, P < .001). CONCLUSIONS Socioeconomic factors, including insurance status and geographic region, are associated with disparities in use of adjuvant therapy as recommended by National Comprehensive Cancer Network guidelines. These disparities significantly impact patient survival. Future work should focus on improving access to appropriate adjuvant therapies among the under insured and socioeconomically disadvantaged.
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Affiliation(s)
- Norma E Farrow
- Department of Surgery, Duke University Medical Center, Durham, NC.
| | - Selena J An
- Duke University School of Medicine, Durham, NC
| | - Paul J Speicher
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - David H Harpole
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Thomas A D'Amico
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Jacob A Klapper
- Department of Surgery, Duke University Medical Center, Durham, NC
| | | | - Betty C Tong
- Department of Surgery, Duke University Medical Center, Durham, NC
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Fletcher SA, Cole AP, Lu C, Marchese M, Krimphove MJ, Friedlander DF, Mossanen M, Kilbridge KL, Kibel AS, Trinh QD. The impact of underinsurance on bladder cancer diagnosis, survival, and care delivery for individuals under the age of 65 years. Cancer 2019; 126:496-505. [PMID: 31626340 DOI: 10.1002/cncr.32562] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 08/24/2019] [Accepted: 09/17/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Health insurance is a key mediator of health care disparities. Outcomes in bladder cancer, one of the costliest diseases to treat, may be especially sensitive to a patient's insurance status. METHODS The Surveillance, Epidemiology, and End Results registry and the National Cancer Data Base were used to identify individuals younger than 65 years who were diagnosed with bladder cancer from 2007 to 2014. The associations between the insurance status (privately insured, insured by Medicaid, or uninsured) and the following outcomes were evaluated: diagnosis with advanced disease, cancer-specific survival, delay in treatment longer than 90 days, treatment in a high-volume hospital, and receipt of neoadjuvant chemotherapy (NAC). RESULTS Compared with those with private insurance, uninsured and Medicaid-insured individuals were nearly twice as likely to receive a diagnosis of muscle-invasive bladder cancer (odds ratio [OR] for uninsured individuals, 1.90; 95% confidence interval [CI], 1.70-2.12; OR for Medicaid-insured individuals, 2.03; 95% CI, 1.87-2.20). They were also more likely to die of bladder cancer (adjusted hazard ratio [AHR] for uninsured individuals, 1.49; 95% CI, 1.31-1.71; AHR for Medicaid-insured individuals, 1.61; 95% CI, 1.46-1.79). Delays in treatment longer than 90 days were more likely for uninsured (OR, 1.36; 95% CI, 1.12-1.65) and Medicaid-insured individuals (OR, 1.22; 95% CI, 1.03-1.44) in comparison with the privately insured. Uninsured patients had lower odds of treatment at a high-volume facility, and Medicaid-insured patients had lower odds of receiving NAC (P < .001 for both). CONCLUSIONS Compared with privately insured individuals, uninsured and Medicaid-insured individuals experience worse prognoses and poorer care quality. Expanding high-quality insurance coverage to marginalized populations may help to reduce the burden of this disease.
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Affiliation(s)
- Sean A Fletcher
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alexander P Cole
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Chang Lu
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Maya Marchese
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marieke J Krimphove
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - David F Friedlander
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Matthew Mossanen
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kerry L Kilbridge
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Adam S Kibel
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Quoc-Dien Trinh
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Alese OB, Jiang R, Zakka KM, Wu C, Shaib W, Akce M, Behera M, El-Rayes BF. Analysis of racial disparities in the treatment and outcomes of colorectal cancer in young adults. Cancer Epidemiol 2019; 63:101618. [PMID: 31600666 DOI: 10.1016/j.canep.2019.101618] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 09/24/2019] [Accepted: 09/29/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND The incidence of colorectal cancer (CRC) in young adults is increasing. Minority populations with CRC are known to have worse survival outcomes. The aim of this study is to evaluate adults under age 50 years with CRC by race and ethnicity. METHODS Data were obtained from all US hospitals that contributed to the National Cancer Database (NCDB) between 2004 and 2013. Univariate and multivariable testing was done to identify factors associated with patient outcome. Kaplan-Meier analysis and Cox proportional hazards models were used for association between patient characteristics and survival. RESULTS A total of 83,449 patients between 18 and 50 years of age were identified. Median age was 45 years (SD ± 6), with male preponderance (53.9%). 72% were non-Hispanic Whites (NHW), Blacks (AA) were 15.1% and Hispanics (who did not identify as Blacks) were 8.3% of the study population. Distribution across stages IIV was 15.6%, 22.4%, 33.9% and 27% consecutively. 41.8% of NHW and 28.4% of AA had rectal cancers (p < 0.001). Despite equally receiving standard of care (SOC) as per national guidelines, AA had significantly lower 5-year survival rates (58.8%) compared to Hispanics (64.8%) and NHW (66.9%; HR 1.42; 1.38-1.46; p < 0.001). Furthermore, NHW (HR 0.85; 0.81-0.88; p < 0.001) and Hispanics (HR 0.75; 0.70-0.79; p < 0.001) were more likely to benefit from chemotherapy compared to AA. SOC utilization was associated with improved survival across all racial groups, especially in AA (HR 0.64; 0.60-0.69; p < 0.001). CONCLUSION Despite comparable rates of SOC utilization, AA young adults had worse survival outcomes compared to other races. More colon (compared to rectal) cancers in AA may have contributed to their worse outcomes.
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Affiliation(s)
- Olatunji B Alese
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
| | - Renjian Jiang
- Winship Research Informatics, Emory University, Atlanta, GA, USA
| | - Katerina M Zakka
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Christina Wu
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Walid Shaib
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Mehmet Akce
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Madhusmita Behera
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA; Winship Research Informatics, Emory University, Atlanta, GA, USA
| | - Bassel F El-Rayes
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
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Ford ME, Sterba KR, Armeson K, Malek AM, Knight KD, Zapka J. Factors Influencing Adherence to Recommended Colorectal Cancer Surveillance: Experiences and Behaviors of Colorectal Cancer Survivors. J Cancer Educ 2019; 34:938-949. [PMID: 30073494 PMCID: PMC6359985 DOI: 10.1007/s13187-018-1398-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The number of colorectal cancer (CRC) survivors in the USA is increasing and factors associated with CRC surveillance require attention. This study examined the role of personal, provider, and practice-level factors on CRC survivor care surveillance experiences and outcomes. A telephone survey, informed by the Chronic Care Model, was conducted over a 1-year period with 150 CRC survivors identified via the South Carolina Central Cancer Registry. Participants were ages ≥ 21 years and diagnosed with stages I-III CRC within 1.5 years of study enrollment. Data were analyzed using descriptive statistics and logistic regression. Adherence was defined as receipt of surveillance colonoscopy at 13 months post-CRC surgery, as recommended by evidence-based guidelines. The majority of participants were male (55%) and white (86%), with a median age of 65 years (range 25-89). Almost half (43%) had attained a high school degree or less. Cancer stage was fairly evenly distributed, and 58% had received treatment by surgery alone (provider-level factor). Few participants (56%) received a survivorship care plan (practice-level factor), and adherence to surveillance colonoscopy was lowest (36%) among participants with more than one comorbidity (personal-level factor). Logistic regression models showed that the only significant effect of personal, provider, or practice-level factors on CRC surveillance adherence was related to type of health insurance coverage (private/HMO vs. other; p = 0.04). This is one of the first studies to evaluate CRC surveillance in a socioeconomically diverse sample. The only associations found among the examined factors and adherence were related to type of health insurance coverage. Participants with private/HMO health insurance were significantly more likely than participants with "other" health insurance coverage types (i.e., none, Medicare without supplement, Medicare with supplement) to be adherent to the 13-month colonoscopy. Therefore, future education strategies and patient navigation interventions could focus on identifying and overcoming multi-level barriers to CRC surveillance services.
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Affiliation(s)
- Marvella E Ford
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA.
| | - Katherine R Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Kent Armeson
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Angela M Malek
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Kendrea D Knight
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Jane Zapka
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA
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Sharma M, Ugiliweneza B, Boakye M, Andaluz N, Williams BJ. Feasibility of Bundled Payments in Anterior, Middle, and Posterior Cranial Fossa Skull Base Meningioma Surgery: MarketScan Analysis of Health Care Utilization and Outcomes. World Neurosurg 2019; 131:e116-e127. [PMID: 31323403 DOI: 10.1016/j.wneu.2019.07.078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 07/06/2019] [Accepted: 07/08/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND The aim of our study was to compare the health care utilization and outcomes after surgery for anterior cranial fossa skull base meningioma (AFM), middle cranial fossa skull base meningioma (MFM), and posterior cranial fossa skull base meningioma (PFM) across the United States. METHODS We queried the MarketScan database using International Classification of Diseases, Ninth Revision and Current Procedural Terminology 4, from 2000 to 2016. We included adult patients who had at least 24 months of enrollment after the surgical procedure. The outcome of interest was length of hospital stay, disposition, complications, and reoperation after the procedure. RESULTS A cohort of 1191 patients was identified from the database. Less than half of patients (43.66%) were in the AFM cohort, 32.24% were in the MFM cohort, and only 24.1% were in the PFM cohort. Patients who underwent surgery for PFM had longer hospital stay (P = 0.0009), high complication rate (P = 0.0011), and less likely to be discharged home (P = 0.0013) during index hospitalization. There were no differences in overall payments at 12 months and 24 months among the cohorts. There was no significant difference in 90-day median payments among the groups ($66,212 [AFM] vs. $65,602 [MFM] and $71,837 [PFM]; P = 0.198). Male gender, commercial insurance (compared with Medicare), and higher comorbidity scores (score 3 compared with score 0) were associated with higher 90-day payments in the PFM cohort. CONCLUSIONS Overall payments (at 12 months and 24 months) and 90-day payments were not different among the cohorts. Patients with PFM had longer hospital stay and higher complication rate and were less likely to be discharged home with higher utilization of outpatient services at 12 months and 24 months.
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Affiliation(s)
- Mayur Sharma
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | | | - Maxwell Boakye
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Noberto Andaluz
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Brian J Williams
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA.
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McDougall JA, Blair CK, Wiggins CL, Goodwin MB, Chiu VK, Rajput A, Kinney AY. Socioeconomic disparities in health-related quality of life among colorectal cancer survivors. J Cancer Surviv 2019; 13:459-467. [PMID: 31111302 DOI: 10.1007/s11764-019-00767-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 05/10/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE Improvements in colorectal cancer (CRC) prevention, early detection, and treatment have resulted in substantial gains in survival. However, the health-related quality of life (HRQoL) of CRC survivors often depends on access to supportive care, which differs by survivors' socioeconomic characteristics. The purpose of this study was to investigate the relationship between socioeconomic characteristics and HRQoL in a diverse group of CRC survivors. METHODS We conducted a population-based, cross-sectional study to examine the association between socioeconomic factors (household income, health literacy, and insurance status) and HRQoL domains of pain interference, fatigue, physical function, sleep disturbance, anxiety, and depression. PROMIS® Short Forms v.2.0 were used to assess domains of HRQoL. Linear regression modeling was used to estimate the coefficient representing the average HRQoL domain score and its 95% confidence interval (CI). RESULTS Three hundred one CRC survivors participated in the survey. Low-income (≤ $30,000) CRC survivors had, on average, a 4.70-point (95% CI 1.10-8.28) higher pain interference score, a 7.02-point (95% CI 3.27-10.77) higher fatigue score, a 5.13-point (95% CI - 8.56 to - 1.71) lower physical function score, and a 4.44-point (95% 1.40-7.49) higher depression score than CRC survivors with an income ≥ $70,000. Survivors with Medicaid insurance reported significantly greater pain interference and worse physical function than privately insured survivors. Survivors with low health literacy reported significantly greater pain interference compared with survivors with high health literacy. CONCLUSIONS Substantial socioeconomic disparities in HRQoL were observed in this diverse population of CRC survivors. IMPLICATIONS FOR CANCER SURVIVORS Designing supportive care interventions to improve HRQoL among low-income and Medicaid-insured CRC survivors is critical for eliminating disparities in CRC outcomes.
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Affiliation(s)
- Jean A McDougall
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA. .,Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA. .,University of New Mexico, MSC105550, Albuquerque, NM, 87131-0001, USA.
| | - Cindy K Blair
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA.,Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Charles L Wiggins
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA.,Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Michael B Goodwin
- Department of Economics, University of New Mexico, Albuquerque, NM, USA
| | - Vi K Chiu
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA.,Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Ashwani Rajput
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA.,Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Anita Y Kinney
- Rutgers, School of Public Health, The State University of New Jersey, New Brunswick, NJ, USA
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Franzoi MA, Schwartsmann G, de Azevedo SJ, Geib G, Zaffaroni F, Liedke PER. Differences in Breast Cancer Stage at Diagnosis by Ethnicity, Insurance Status, and Family Income in Young Women in the USA. J Racial Ethn Health Disparities 2019; 6:909-16. [PMID: 31102102 DOI: 10.1007/s40615-019-00591-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/29/2019] [Accepted: 04/03/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE Describe the clinical and epidemiological data from young women with breast cancer and determine the association between ethnicity, insurance status, family income, and breast cancer stage at the diagnosis in this population. METHODS Women under the age of 40 diagnosed with invasive breast cancer from 2010 to 2014 and identified in the Surveillance, Epidemiology, and End Results (SEER) 18 registries database were included. Binary logistic regression was applied in order to estimate the odds ratios (ORs) for factors that were potentially predictive for receiving a breast cancer diagnosis at stage I. RESULTS Of 14,379 young women with invasive breast cancer, 70.9% of the patients were white, 15.9% black, and 13.2% classified as other ethnicity (American Indian, Asian, Pacific Islander). The initial clinical stage at diagnosis was stage I in 28.2%, II in 45.2%, III in 19.0%, and IV in 7.6%. The chi-square test showed a significant association between clinical stage at diagnosis and family income (p < 0.0001), insurance status (p < 0.0001), and ethnicity (p < 0.0001). The ORs for being diagnosed at stage I, regarding different factors, revealed that women with family income higher than US$ 85,000 were more likely to be diagnosed with stage I (OR [95%CI], 1.306 [1.173-1.454]; p value < 0.0001) when compared with patients with family income of less than US$ 60,000. Black women were less likely to be diagnosed with stage I (OR [95%CI], 0.676 [0.605-0.755]; p value < 0.0001), when compared with white women. Uninsured women were less likely to be diagnosed with stage I (OR [95%CI], 0.586 [0.529-0.648]; p value < 0.0001) when compared with women with insurance coverage. CONCLUSION Among young US women diagnosed with invasive breast cancer, most of them presented early stage disease. Women with black ethnicity, low income, and uninsured are at risk for late-stage presentation. Improvements in strategies to allow earlier breast cancer diagnosis in these at risk population are urged.
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Sharma M, Dietz N, Ugiliweneza B, Wang D, Drazin D, Boakye M. Differences in clinical outcomes and health care utilization between octogenarians and nonagenarians following decompression for lumbar spinal stenosis. A market scan analysis. Clin Neurol Neurosurg 2019; 182:63-69. [PMID: 31082620 DOI: 10.1016/j.clineuro.2019.04.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/02/2019] [Accepted: 04/30/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Lumbar spinal stenosis (LSS) in octogenarians and beyond has a significant impact on quality of life requiring surgical decompression and hence impact on health care utilization. Risk of surgical failure and impact on health care resources is always a concern in this patient population (more so in nonagenarians). The aim of our study was to compare clinical outcomes and healthcare utilization in patients (80-89 vs.90+) undergoing decompression for LSS. PATIENTS AND METHODS Data was extracted using ICD9/10 and CPT codes from MarketScan (2001-2015) in this retrospective study. We defined the comparative groups based on the age groups (80-89 and 90+), in patients with LSS. Outcomes of interest were: length of hospital stay, discharge disposition and utilization in the index hospitalization, 6- months, 12 months following index procedure as well as the associated health care utilization. Patient characteristics and outcomes among cohorts were compared using univariate tests. Outcomes were further compared using adjusted multivariable regression models. Statistical analysis was performed with SAS 9.4. RESULTS A cohort of 5387 was identified from the database, 96.38% were in the 80-89 age group and 3.62%were in the 90+ age group. The proportion of patients undergoing surgery for LSS among 80-89 (95.7-98.5%) and 90+ age group (1.5-4.3%) remained constant through the years. Interestingly, 13.83% and 16.92% of patients had Elixhauser comorbidity index of 3+ in 80-89 age group and 90+ age groups respectively. Decompression with fusion was performed in 19.4% of patients in 80-89 age group, compared to 9.74% of patients in 90+ age group. There was no difference in median length of hospital stay (3 days, p = 0.19) and complications across the cohorts (80-89: 16.7%; 90+: 18.46% p = 0.51). 70.6% of patients in 80-89 age groups were discharged to home compared to 60.5% in 90+ age group (p = 0.0023). At 6 months follow-up, overall rate of new decompression, new fusion, re-fusion at index level were 2.38%, 0.59% and 0.33% only, with no differences across the cohorts. Interestingly, patients in 80-89 age group incurred higher outpatient services, number of medication refills and related payments at 6-months and 12-months follow-up, compared to patients in 90+ age group. Overall, combined median post-discharge payments at 12 months were similar across the groups [80-89 (median $ 40,257) and 90+ (median$ 36,161), p = 0.14]. CONCLUSION Using MarketScan database, there has been a gradual decline in the number of decompressions being performed for LSS in elderly patients (>80 years of age), however there is no change in the proportion of octogenarians and nonagenarians undergoing decompression for LSS. There was no difference in rate of reoperations and overall health care utilization among the groups. Surgery for LSS can be offered to nonagenarians (in appropriately selected patients) with no difference in clinical outcomes and health care utilization, compared to octogenarians.
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Affiliation(s)
- Mayur Sharma
- Department of Neurosurgery, University of Louisville, 200 Abraham Flexner Hwy, Louisville, KY, 40202, USA
| | - Nicholas Dietz
- Department of Neurosurgery, University of Louisville, 200 Abraham Flexner Hwy, Louisville, KY, 40202, USA
| | - Beatrice Ugiliweneza
- Department of Neurosurgery, University of Louisville, 200 Abraham Flexner Hwy, Louisville, KY, 40202, USA
| | - Dengzhi Wang
- Department of Neurosurgery, University of Louisville, 200 Abraham Flexner Hwy, Louisville, KY, 40202, USA
| | - Doniel Drazin
- Pacific Northwest University of Health Sciences College of Medicine, Yakima, WA, USA
| | - Maxwell Boakye
- Department of Neurosurgery, University of Louisville, 200 Abraham Flexner Hwy, Louisville, KY, 40202, USA.
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Wang AA, Tapia C, Bhanji Y, Campbell C, Larsen D, Gross D, Ganatra S, Qodsi M, Tellez C, Jain S. Barriers to receipt of novel oral oncolytics: A single-institution quality improvement investigation. J Oncol Pharm Pract 2019; 26:279-285. [PMID: 30943846 DOI: 10.1177/1078155219841424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Novel oral oncolytic agents have become the standard of care and first-line therapies for many malignancies. However, issues impacting access to these drugs are not well explored. As part of a quality improvement project in a large tertiary academic institution, we aim to identify potential barriers that delay treatment for patients who are prescribed novel oral oncolytics. METHODS This was a retrospective review of adults who were newly prescribed a novel oral oncolytic for Food and Drug Administration-approved indications at a single tertiary care center. Patients were identified via electronic prescription data (e-Scribe). Demographics, insurance information, and prescription dates were extracted from the electronic medical record and pharmacy claims data. Statistical analyses were performed to determine whether time-to-receipt was associated with insurance category, pharmacy transfers, cost assistance, and drug prescribed. RESULTS Of the 270 successfully filled prescriptions, the mean time-to-receipt was 7.3 ± 10.3 days (range: 0-109 days). Patients with Medicare experienced longer time-to-receipt (9.1 ± 13.1 days) compared to patients with commercial insurance (4.4 ± 3.3). Uninsured patients experienced the longest time-to-receipt (15.7 ± 7.8 days) overall. Pharmacy transfers and cost assistance programs were also significantly associated with longer time-to-receipt. Ten prescriptions remained unfilled 90 days after the study period and were considered abandoned. CONCLUSION Insurance has a significant effect on the time-to-receipt of newly prescribed novel oral oncolytics. Pharmacy transfers and applying for cost assistance are also associated with longer wait times for patients. Our retrospective analysis identifies areas of improvement for future interventions to reduce wait times for patients receiving novel oral oncolytics.
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Affiliation(s)
- Ann A Wang
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Christopher Tapia
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Yasin Bhanji
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Daniel Larsen
- Department of Medicine (Hematology and Oncology), Northwestern Medicine, Chicago, IL, USA
| | - Derick Gross
- Hematology Oncology Program, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Seema Ganatra
- Hematology Oncology Program, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Melad Qodsi
- Hematology Oncology Program, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Claudia Tellez
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Medicine (Hematology and Oncology), Northwestern Medicine, Chicago, IL, USA
| | - Shikha Jain
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Medicine (Hematology and Oncology), Northwestern Medicine, Chicago, IL, USA
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Sun W, Cheng M, Zhuang S, Qiu Z. Impact of Insurance Status on Stage, Treatment, and Survival in Patients with Colorectal Cancer: A Population-Based Analysis. Med Sci Monit 2019; 25:2397-2418. [PMID: 30939127 PMCID: PMC6457135 DOI: 10.12659/msm.913282] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 10/24/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND This study aimed to analyze data from the Surveillance, Epidemiology, and End Results (SEER) program to identify patients with colorectal cancer (CRC) who had specific insurance details and the effects of stage at diagnosis, definitive treatment, and survival outcome with insurance status. MATERIAL AND METHODS Between 2007 and 2009, SEER database analysis identified 54,232 patients with CRC. Logistic models examined the associations between insurance status and disease stage and definitive treatment. Kaplan-Meier analysis, the Cox model, and the Fine and Gray model were used to compare the tumor cause-specific survival (TCSS) for patients with different insurance status. RESULTS Insured patients were more likely to have earlier tumor stage at diagnosis when compared with patients receiving Medicaid (adjusted OR, 1.318; 95% CI, 1.249-1.391; P<0.001) and when compared with uninsured patients (adjusted OR, 1.479; 95% CI, 1.352-1.618; P<0.001). Insured patients were significantly more likely to undergo definitive treatment when compared with patients receiving Medicaid (adjusted OR, 0.591; 95% CI, 0.470-0.742; P<0.001) and compared with patients who were uninsured (adjusted OR, 0.404; 95% CI, 0.282-0.579; P<0.001). Insured patients had a significantly increased TCSS when compared with patients receiving Medicaid (HR, 1.298; 95% CI, 1.236-1.363; P<0.001) and compared with patients who were uninsured (HR 1.195, 95% CI, 1.100-1.297; P<0.001). CONCLUSIONS Insurance status was a significant factor that determined early diagnosis, definitive treatment, and clinical outcome and was an independent factor for TCSS in patients with CRC.
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Patel A, Gantz O, Zagadailov P, Merchant AM. The role of socioeconomic disparity in colorectal cancer stage at presentation. Updates Surg 2019; 71:523-31. [DOI: 10.1007/s13304-019-00632-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 02/12/2019] [Indexed: 12/16/2022]
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Sharma M, Ugiliweneza B, Sirdeshpande P, Wang D, Boakye M. Opioid Dependence and Health Care Utilization After Decompression and Fusion in Patients With Adult Degenerative Scoliosis. Spine (Phila Pa 1976) 2019; 44:280-90. [PMID: 30015717 DOI: 10.1097/BRS.0000000000002794] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To identify factors associated with opioid dependence after surgery for adult degenerative scoliosis (ADSc). SUMMARY OF BACKGROUND DATA Opioid epidemic is of prodigious concern throughout the United States. METHODS Data was extracted using national MarketScan database (2000-2016). Opioid dependence was defined as continued opioid use or >10 opioid prescriptions for 1 year either before or 3 to 15 months after the procedure. Patients were segregated into four groups based on opioid dependence before and postsurgery: NDND (before nondependent who remain non-dependent), NDD (before nondependent who become dependent), DND (before dependent who become non-dependent) and DD (before dependent who remain dependent). Outcomes were discharge disposition, length of stay, complications, and healthcare resource utilization. RESULTS Approximately, 35.82% (n = 268) of patients were identified to have opioid dependence before surgery and 28.34% (n = 212) were identified to have opioid dependence after surgery for ADSc. After surgical fusion for ADSc, patients were twice likely to become opioid independent than they were to become dependent (13.77% vs. 6.28%, OR: 2.191, 95% CI: 21.552-3.094; P < 0.0001). Before opioid dependence (RR: 14.841; 95% CI: 9.867, 22.323; P < 0.0001) was identified as a significant predictor of opioid dependence after surgery for ADSc. In our study, 57.9%, 6.28%, 13.77%, and 22.06% of patients were in groups NDND, NDD, DND, and DD respectively. DD and NDD were likely to incur 3.03 and 2.28 times respectively the overall costs compared with patients' ingroup NDND (P < 0.0001), at 3 to 15 months postsurgery (median $21648 for NDD; $40,975 for DD; and $ 13571 for NDND groups). CONCLUSION Surgery for ADSc was not associated with increased likelihood of opioid dependence, especially in opioid naïve patients. Patients on regular opiate treatment before surgery were likely to remain on opiates after surgery. Patients who continued to be opioid dependent or become dependent after surgery incur significantly higher healthcare utilization at 3 and 3 to 15 months. LEVEL OF EVIDENCE 4.
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Sharma M, Dietz N, Alhourani A, Ugiliweneza B, Wang D, Drazin D, Boakye M. Insights into complication rates, reoperation rates, and healthcare utilization associated with use of recombinant human bone morphogenetic protein–2 in patients with spine infections. Neurosurg Focus 2019; 46:E8. [DOI: 10.3171/2018.10.focus18448] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 10/30/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEUse of recombinant human bone morphogenetic protein–2 (rhBMP-2) in patients with spine infections is controversial. The purpose of this study was to identify long-term complications, reoperations, and healthcare utilization associated with rhBMP-2 use in patients with spine infections.METHODSThis retrospective study extracted data using ICD-9/10 and CPT codes from MarketScan (2000–2016). Patients were dichotomized into 2 groups (rhBMP-2, no rhBMP-2) based on whether rhBMP-2 was used during fusion surgery for spinal infections. Outcomes of interest were reoperation rates (index level, other levels), readmission rates, discharge disposition, length of stay, complications, and healthcare resource utilization at the index hospitalization and 1, 3, 6, 12, and 24 months following discharge. Outcomes were compared using nonparametric 2-group tests and generalized linear regression models.RESULTSThe database search identified 2762 patients with > 24 months’ follow-up; rhBMP-2 was used in 8.4% of their cases. The patients’ median age was 53 years, 52.43% were female, and 15.11% had an Elixhauser Comorbidity Index ≥ 3. Patients in the rhBMP-2 group had higher comorbidity indices, incurred higher costs at index hospitalization, were discharged home in most cases, and had lower complication rates than those in the no–rhBMP-2 group. There was no statistically significant between-groups difference in complication rates 1 month following discharge or in reoperation rates at 3, 6, 12, and 24 months following the procedure. Patients in the no–rhBMP-2 group incurred higher utilization of outpatient services and medication refill costs at 1, 3, 6, 12, and 24 months following surgery.CONCLUSIONSIn patients undergoing surgery for spine infection, rhBMP-2 use was associated with lower complication rates and higher median payments during index hospitalization compared to cases in which rhBMP-2 was not used. There was no significant between-groups difference in reoperation rates (index and other levels) at 3, 6, 12, and 24 months after the index operation. Patients treated with rhBMP-2 incurred lower utilization of outpatient services and overall payments. These results indicate that rhBMP-2 can be used safely in patients with spine infections with cost-effective utilization of healthcare resources and without an increase in complications or reoperation rates.
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Affiliation(s)
- Mayur Sharma
- 1Department of Neurosurgery, University of Louisville, Louisville, Kentucky; and
| | - Nicholas Dietz
- 1Department of Neurosurgery, University of Louisville, Louisville, Kentucky; and
| | - Ahmad Alhourani
- 1Department of Neurosurgery, University of Louisville, Louisville, Kentucky; and
| | - Beatrice Ugiliweneza
- 1Department of Neurosurgery, University of Louisville, Louisville, Kentucky; and
| | - Dengzhi Wang
- 1Department of Neurosurgery, University of Louisville, Louisville, Kentucky; and
| | - Doniel Drazin
- 2Evergreen Hospital Neuroscience Institute, Kirkland, Washington
| | - Maxwell Boakye
- 1Department of Neurosurgery, University of Louisville, Louisville, Kentucky; and
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Dietz N, Sharma M, Alhourani A, Ugiliweneza B, Wang D, Nuño M, Drazin D, Boakye M. Outcomes of decompression and fusion for treatment of spinal infection. Neurosurg Focus 2019; 46:E7. [DOI: 10.3171/2018.10.focus18460] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVESpine infection including vertebral osteomyelitis, discitis, paraspinal musculoskeletal infection, and spinal abscess refractory to medical management poses significant challenges to the treating physician. Surgical management is often required in patients suffering neurological deficits or spinal deformity with significant pain. To date, best practices have not been elucidated for the optimization of health outcomes and resource utilization in the setting of surgical intervention for spinal infection. The authors conducted the present study to assess the magnitude of reoperation rates in both fusion and nonfusion groups as well as overall health resource utilization following surgical decompression for spine infection.METHODSThe authors performed an analysis using MarketScan (2001–2015) to identify health outcomes and healthcare utilization metrics of spine infection following surgical intervention with decompression alone or combined with fusion. Adult patients underwent surgical management for primary or secondary spinal infection and were followed up for at least 12 months postoperatively. Assessed outcomes included reoperation, healthcare utilization and payment at the index hospitalization and within 12 months after discharge, postoperative complications, and infection recurrence.RESULTSA total of 2662 patients in the database were eligible for inclusion in this study. Rehospitalization for infection was observed in 3.99% of patients who had undergone fusion and in 11.25% of those treated with decompression alone. Reoperation was needed in 12.7% of the patients without fusion and 8.16% of those with fusion. Complications within 30 days were more common in the nonfusion group (24.64%) than in the fusion group (16.49%). Overall postoperative payments after 12 months totaled $33,137 for the nonfusion group and $23,426 for the fusion group.CONCLUSIONSIn this large cohort study with a 12-month follow-up, the recurrence of infection, reoperation rates, and complications were higher in patients treated with decompression alone than in those treated with decompression plus fusion. These findings along with imaging characteristics, disease severity, extent of bony resection, and the presence of instability may help surgeons decide whether to include fusion at the time of initial surgery. Further studies that control for selection bias in appropriately matched cohorts are necessary to determine the additive benefits of fusion in spinal infection management.
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Affiliation(s)
- Nicholas Dietz
- 1Department of Neurosurgery, University of Louisville, Louisville, Kentucky
| | - Mayur Sharma
- 1Department of Neurosurgery, University of Louisville, Louisville, Kentucky
| | - Ahmad Alhourani
- 1Department of Neurosurgery, University of Louisville, Louisville, Kentucky
| | | | - Dengzhi Wang
- 1Department of Neurosurgery, University of Louisville, Louisville, Kentucky
| | - Miriam Nuño
- 2Department of Public Health Sciences, Division of Biostatistics, University of California, Davis, California; and
| | - Doniel Drazin
- 3Evergreen Hospital Neuroscience Institute, Kirkland, Washington
| | - Maxwell Boakye
- 1Department of Neurosurgery, University of Louisville, Louisville, Kentucky
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Chipollini J, Tang DH, Zhou J, Reich RR, Leone AR, Gilbert SM, Sexton WJ. Trends in Insurance Status during Initial Presentation of Testicular Carcinoma: Examining Health Outcomes and Implications of Health Reform for Young Adults in the United States. Urology Practice 2019; 6:18-23. [DOI: 10.1016/j.urpr.2018.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Osagiede O, Spaulding AC, Frank RD, Merchea A, Uitti R, Ailawadhi S, Kelley S, Colibaseanu D. Predictors of palliative treatment in stage IV colorectal cancer. Am J Surg 2018; 218:514-520. [PMID: 30578033 DOI: 10.1016/j.amjsurg.2018.12.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 12/10/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Palliative treatment may be associated with prolonged survival and improved quality of life, but remains underutilized in stage IV colorectal (CRC). We examined a national cohort of stage IV CRC patients to determine the factors associated with palliative treatment. METHODS Stage IV CRC patients, classified based on their survival length (<6 months, 6-24 months, and 24 + months), were analyzed using the American College of Surgeons National Cancer Data Base (2004-2013). Multivariable analysis was performed to evaluate factors associated with palliative treatment. RESULTS Of 85,981 patients analyzed, 10.9% received palliative treatment. For 6-24 months survival, a more recent year of diagnosis, Medicaid, uninsured status, Mountain and Pacific regions were associated with higher odds of palliative treatment. For those who survived < 6months, older patients had lower odds, while academic centers and residence > 20 miles from treating institutions were associated with increased likelihood of palliative treatment. CONCLUSIONS Palliative treatment in stage IV CRC is associated with a more recent year of diagnosis, Medicaid, academic centers, Mountain and Pacific regions of the US.
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Affiliation(s)
- Osayande Osagiede
- Department of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, FL, USA; Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Aaron C Spaulding
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - Ryan D Frank
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Amit Merchea
- Department of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Ryan Uitti
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Sikander Ailawadhi
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Scott Kelley
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - Dorin Colibaseanu
- Department of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, FL, USA
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