2017 Resarch Forum

SG: M-4

Applicant: Margaret Mariella MD Principal Investigator: Maureen Martin MD FACS

Timely access to primary surgery, adjuvant chemotherapy and radiation therapy for breast cancer in a public hospital setting is dependent on payer source Margaret Mariella MD, Anna Arakelyan MS III, Heather Hess RN, Maureen Martin MD FACS INTRODUCTION : Patients with breast cancer who are at substantial risk for systemic metastases are increasingly treated by multimodality surgery, chemotherapy and radiation. Although safety net patients qualify for entitlement funding for diagnostic biopsy, they remain vulnerable to delays in subsequent care due to the complexity of arranging long-term funding sources. PURPOSE: To evaluate factors associated with delays in definitive care in patients with breast cancer managed at our public safety net hospital. METHOD: Institutional IRB approval was obtained to query medical records of patients undergoing breast cancer surgery at our facility between January 2014 and January 2016. Patient demographics, insurance status, stage and type of procedure, timing of chemotherapy (AC) and radiation therapy (AR) initiation were collected. Factors associated with time to adjuvant treatment were determined using multivariate regression models analysis. RESULTS: During this time 180 female patients with an average age (42.2 years) underwent surgical treatment including breast conservation (38), skin sparing mastectomy (49), or modified radical mastectomy (74). Early stage I or II cancer was noted in 153 patients (85%). Payer status and time to start of surgery, AC or AR are presented in table 1.

Stage I-II

Stage III-IV

Days to Surgery 144.17

p- value 0.016 0.095 0.522 0.125

Payer

(n)

Odds Ratio

Medicaid 82

69

8

4.12

Managed Medical

44

41 10

2 0 0 0

102.5 128.6

0.4324 0.5946 0.3346

Medicare 10

BCCTP Private

9 3

8 3

118.89

56

N/A

0.99

Days to Chemo (n)

Odds Ratio

p- value

Days to Radiation (n)

Odds Ratio

p- value

Payer

Medicaid 105.45

70 2.3658 0.0256

317.62 45 0.878 0.7052

Managed Medical

129.57

30 0.6091

0.21

232.63 24 0.8961 0.7695

Medicare 111.14

7 0.7953 0.745 7 0.5022 0.295 2 0.2917 0.226

261.78

9 6.1873 0.0881 6 0.7373 0.629 1 0.625 0.7414

BCCTP Private

106.57

162 331

115

CONCLUSIONS: The majority of patients in our program present with early stage disease. Low-income BCCTP patients receive timely care however patients enrolled in Medicaid suffer significant delay in time to surgery and receipt of subsequent adjuvant chemotherapy and/or radiation.