Posts Tagged ‘insurance’

Increase seen in use of double mastectomy, although not associated with reduced death

Randomized trials have demonstrated similar survival for patients with early-stage breast cancer treated with breast-conserving surgery and radiation or with mastectomy. However, previous data show increasing use of mastectomy, and particularly bilateral mastectomy (removal of both breasts) among U.S. patients with breast cancer. Evidence for a survival benefit with this procedure appears limited to rare patient subgroups. “Because bilateral mastectomy is an elective procedure for unilateral breast cancer [in one breast] and may have detrimental effects in terms of complications and associated costs as well as body image and sexual function, a better understanding of its use and outcomes is crucial to improving cancer care,” according to background information in the article.

Allison W. Kurian, M.D., M.Sc., of the Stanford University School of Medicine, Stanford, Calif., and colleagues used data from the California Cancer Registry from 1998 through 2011 to compare the use of and rate of death after bilateral mastectomy, breast-conserving therapy with radiation, and unilateral mastectomy (removal of one breast).

The analyses included 189,734 patients. The researchers found that the rate of bilateral mastectomy increased from 2.0 percent in 1998 to 12.3 percent in 2011, an annual increase of 14.3 percent. The increase in bilateral mastectomy rate was greatest among women younger than 40 years: the rate increased from 3.6 percent in 1998 to 33.0 percent in 2011, increasing by 17.6 percent annually. Use of unilateral mastectomy declined in all age groups

Bilateral mastectomy was more often used by non-Hispanic white women, those with private insurance, and those who received care at a National Cancer Institute-designated cancer center; in contrast, unilateral mastectomy was more often used by racial/ethnic minorities and those with public/Medicaid insurance.

Compared with breast-conserving surgery with radiation, bilateral mastectomy was not associated with a mortality difference, whereas unilateral mastectomy was associated with higher mortality.

“In a time of increasing concern about overtreatment, the risk-benefit ratio of bilateral mastectomy warrants careful consideration and raises the larger question of how physicians and society should respond to a patient’s preference for a morbid, costly intervention of dubious effectiveness,” the authors write.

“These results may inform decision-making about the surgical treatment of breast cancer.”

Editorial: Contralateral Prophylactic Mastectomy: Is It a Reasonable Option?

In an accompanying editorial, Lisa A. Newman, M.D., M.P.H., of the University of Michigan, Ann Arbor, discusses the issues involved with the use of contralateral prophylactic mastectomy (risk-reducing mastectomy for the unaffected breast).

“The need for patients to be accurately informed regarding safe and oncologically acceptable treatment options is indisputable. The dense fog of complex emotions that accompanies a new cancer diagnosis can impair the ability to process this information. Patients should be encouraged to allow the intensity of these immediate reactions to subside before committing to mastectomy prematurely. Physicians should not permit excessive treatment delays to compromise outcomes, but the initial few weeks surrounding the diagnosis are more effectively utilized by time invested in patient education and procedures that contribute to comprehensive treatment planning as opposed to hastily coordinating impulsive, irreversible surgical plans.”

source : http://www.sciencedaily.com/releases/2014/09/140902171150.htm

Patients with MS may be at increased risk of developing cancer

Previous research suggests that some individuals with autoimmune diseases may have an increased risk of developing cancer, but most studies have found no link between cancer and multiple sclerosis, an autoimmune disease that involves the central nervous system.

To investigate further, Li-Min Sun, MD, of the Zuoying Branch of Kaohsiung Armed Forces General Hospital in Kaohsiung, Taiwan, and his colleagues assessed data from the National Health Insurance System of Taiwan, including information on 1292 patients who were diagnosed with multiple sclerosis between 1997 and 2010. Each patient was matched with four participants without the condition.

"Our study was a nationwide population-based cohort study, and it revealed unexpected findings," said Dr. Sun. Specifically, the team found that individuals with multiple sclerosis were 85% more likely to develop cancer than the controls. Their risk of developing breast cancer was especially high, with more than a 2-fold increased risk over controls.

The findings suggest that patients with multiple sclerosis patients may need to be monitored closely to ensure early detection of cancer. Dr. Sun notes that it is unclear why his team’s results are not consistent with most other studies. "The underlying genetic and environmental factors in Taiwan, which differ from those of western countries, might play an undetermined role. Additional large-scale studies will help improve our understanding," he said.

source : http://www.sciencedaily.com/releases/2014/01/140114130842.htm

Economic factors may affect getting guideline-recommended breast cancer treatment

Women with a break in their insurance coverage had a 3.5-fold higher likelihood of nonconcordance with National Comprehensive Cancer Network (NCCN) guidelines for radiation therapy and chemotherapy compared with women with uninterrupted coverage.

"We found that women who had no insurance at some point during treatment, women with lower incomes compared with those in the highest income categories, and women who held more debt at the time of diagnosis were less likely to receive all of the recommended breast cancer treatments," said Jean A. McDougall, Ph.D., M.P.H., a postdoctoral fellow at the Fred Hutchinson Cancer Research Center in Seattle, Wash. "Documenting and understanding these disparities is important for connecting women who are at high risk for not receiving all of their treatment with a patient navigator or social worker ahead of time so that we might increase the likelihood that they will get recommended treatment."

McDougall and colleagues conducted a population-based cohort study of 1,344 women from the Seattle-Puget Sound area diagnosed with breast cancer between 2004 and 2011. Using data from the cancer registry records, pathology reports, and patient self-reports, the researchers assessed whether or not the treatment received was in concordance with guidelines issued by the NCCN.

The researchers found that women with an annual family income of less than $50,000 were more than twice as likely to have received care that was not in concordance with guidelines for radiation therapy compared with women with an income of greater than $90,000 per year. In addition, they had an almost five times higher likelihood for nonconcordance with chemotherapy guidelines, and an almost four times higher likelihood for nonconcordance with endocrine therapy guidelines.

They also found that women who had consistent financial insecurity or who had debt at the time of cancer diagnosis had an increased likelihood for nonconcordance with American Society of Clinical Oncology/NCCN Quality Measures. In addition, women who had problems talking to a doctor, women who did not have anyone to accompany them for their hospital visits, and women who did not have anyone to take care of them and their household chores, were less likely to receive NCCN guideline-recommended chemotherapy.

"Surprisingly, we found that education or the facility where a woman was treated was not associated with receipt of guideline-recommended care," McDougall said. "Our results suggest that further studies are needed to address the root cause of these inequities, and to develop effective interventions."

source : http://www.sciencedaily.com/releases/2013/12/131209084151.htm