Association of Medicaid Expansion With Timely Receipt of Treatment and Survival Among Patients With HR-Negative, HER2-Positive Breast Cancer.

IF 14.8 2区 医学 Q1 ONCOLOGY
Kewei Sylvia Shi, Xu Ji, Changchuan Jiang, Kathryn J Ruddy, Sharon M Castellino, K Robin Yabroff, Xuesong Han
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引用次数: 0

Abstract

Background: Hormone receptor (HR)-negative, HER2-positive (also called HER2-enriched) breast cancer has no worse prognosis than other breast cancers if it is treated with HER2-targeted therapy. Medicaid expansion under the Affordable Care Act (ACA) has been shown to be associated with improved access to care and outcomes for many cancers, but its association with receipt of care for HR-negative, HER2-positive breast cancer is unknown. We examined the association of Medicaid expansion with receipt of guideline-concordant treatment, time to treatment initiation, and survival among nonelderly women newly diagnosed with HR-negative, HER2-positive breast cancer.

Patients and methods: Women aged 18 to 62 years newly diagnosed with HR-negative, HER2-positive breast cancer between 2010 and 2018 were identified from the National Cancer Database. Outcomes included receipt of stage-based guideline-concordant treatment, timely initiation of treatment (<30 days, <60 days, <90 days from diagnosis), and stage-specific 2-year overall survival. A difference-in-differences (DID) analytic approach compared outcome changes following Medicaid expansion in expansion versus nonexpansion states. Multivariable linear probability models were used to estimate treatment outcomes, and flexible parametric survival models were used to evaluate survival, adjusting for sociodemographic and clinical confounders.

Results: A total of 31,401 patients were included. Medicaid expansion was associated with an increase of 0.58 percentage points (ppt; 95% CI, 0.01-1.16) in receipt of guideline-concordant treatment overall, a 2.43-ppt (95% CI, 0.68-4.18) increase in initiating guideline-concordant treatment <60 days after diagnosis, and a 1.17-ppt (95% CI, 0.02-2.32) increase in 2-year survival rate. The increase in 2-year survival associated with Medicaid expansion was most prominent for patients with stage III disease (DID, 3.81; 95% CI, 0.82-6.80).

Conclusions: Medicaid expansion was associated with improved care and survival for patients with HR-negative, HER2-positive breast cancer, an aggressive cancer type for which prognosis largely depends on access to effective treatment.

医疗补助扩展与 HR 阴性、HER2 阳性乳腺癌患者及时接受治疗和存活率的关系》(Medicaid Expansion With Timely Receipt of Treatment and Survival Among Patients With HR-Negative, HER2-Positive Breast Cancer)。
背景:激素受体(HR)阴性、HER2 阳性(也称为 HER2 富集)乳腺癌如果接受 HER2 靶向治疗,其预后并不比其他乳腺癌差。根据《可负担医疗法案》(ACA)扩大医疗补助范围已被证明与改善许多癌症的治疗机会和治疗效果有关,但其与接受 HR 阴性、HER2 阳性乳腺癌治疗的关系尚不清楚。我们研究了医疗补助计划的扩展与新诊断出患有 HR 阴性、HER2 阳性乳腺癌的非老年女性接受与指南一致的治疗、开始治疗的时间以及存活率之间的关系:从国家癌症数据库中筛选出2010年至2018年间新诊断为HR阴性、HER2阳性乳腺癌的18至62岁女性。结果包括接受基于分期指南的一致性治疗、及时开始治疗(结果:共有 31401 名患者接受了基于分期指南的一致性治疗)、及时开始治疗(结果:共有 11720 名患者接受了基于分期指南的一致性治疗)、及时开始治疗(结果:共有 11720 名患者接受了基于分期指南的一致性治疗):共纳入 31,401 名患者。医疗补助计划的扩大与接受指南协调治疗的总体比例增加 0.58 个百分点(ppt;95% CI,0.01-1.16)和开始指南协调治疗的比例增加 2.43 个百分点(95% CI,0.68-4.18)有关:扩大医疗补助计划与改善 HR 阴性、HER2 阳性乳腺癌患者的护理和生存率有关,这种侵袭性癌症的预后在很大程度上取决于能否获得有效的治疗。
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来源期刊
CiteScore
20.20
自引率
0.00%
发文量
388
审稿时长
4-8 weeks
期刊介绍: JNCCN—Journal of the National Comprehensive Cancer Network is a peer-reviewed medical journal read by over 25,000 oncologists and cancer care professionals nationwide. This indexed publication delivers the latest insights into best clinical practices, oncology health services research, and translational medicine. Notably, JNCCN provides updates on the NCCN Clinical Practice Guidelines in Oncology® (NCCN Guidelines®), review articles elaborating on guideline recommendations, health services research, and case reports that spotlight molecular insights in patient care. Guided by its vision, JNCCN seeks to advance the mission of NCCN by serving as the primary resource for information on NCCN Guidelines®, innovation in translational medicine, and scientific studies related to oncology health services research. This encompasses quality care and value, bioethics, comparative and cost effectiveness, public policy, and interventional research on supportive care and survivorship. JNCCN boasts indexing by prominent databases such as MEDLINE/PubMed, Chemical Abstracts, Embase, EmCare, and Scopus, reinforcing its standing as a reputable source for comprehensive information in the field of oncology.
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