Abstract A140: Factors associated with receipt of guideline-concordant treatment among Medicaid enrollees with breast and colorectal cancer

Abstract

Abstract Purpose: Medicaid enrollees with cancer are less likely to receive treatment consistent with established guidelines. It remains unclear what specific factors are associated with non-receipt or delays in guideline-concordant cancer care among Medicaid patients. In this study, we examine receipt of guideline-concordant Medicaid enrollees with breast or colorectal cancer. Methods: We linked data from the New Jersey State Cancer Registry and Medicaid claims and encounter files for patients diagnosed with a first primary breast (BC) or colorectal (CRC) cancer from 2011-2015. We assess guideline-concordant treatment using National Comprehensive Cancer Network and American Society of Clinical Oncology criteria, which include endocrine therapy within 1 year, radiation therapy within 1 year, and adjuvant chemotherapy within 120 days for BC patients; and, postoperative chemotherapy within 9 months, radiation therapy within 6 months, and adjuvant chemotherapy within 4 months for CRC patients that fit the specific clinical criteria for each guideline. For each guideline, patients were placed in one of the three categories: 1.) on-time concordant care, 2.) delayed concordant care, 3.) non-receipt of concordant care. Delayed concordant care included patients with guideline-directed care outside of the indicated timeframe. We used multivariate ordinal logistic regression to determine the independent effects of demographic, health care utilization, and Medicaid enrollment factors on the 3-level concordance measure. Results: Rates of guideline concordant care were: 69.5% for BC endocrine therapy, 63.4% for BC radiation therapy, 76.4% for BC adjuvant chemotherapy, 69.4% for CRC postoperative chemotherapy, 91.9% for CRC radiation therapy, and 68.4% for CRC adjuvant chemotherapy. An additional 10.1% of BC patients received delayed care for endocrine therapy. An additional 14.1% of CRC patients received delayed care for postoperative chemotherapy. Ordinal logit models showed BC patients enrolled through the New Jersey Cancer Education and Early Detection program had a 29.3 percentage point higher probability of on-time care for endocrine therapy compared to women not enrolled through the program (p<0.001). CRC patients enrolled in managed care compared to fee-for-service had a 44 percentage point higher probability for receiving guideline concordant adjuvant chemotherapy (p<0.001). For a subset of BC and CRC guidelines we observed Hispanic patients had lower probably of receiving delayed or non-concordant care compared to NH-White patients (p<0.05). Conclusions: We identified several demographic and enrollment predictors of delayed guideline-concordant treatment for low-income cancer patients. These findings can inform providers to prioritize the targeting of care management resources for patients at high risk for not meeting treatment guidelines and highlight. Citation Format: Jennifer Tsui, Derek DeLia, Jose Nova, Antoinette Stroup, Dawn L. Hershman, Joel Cantor. Factors associated with receipt of guideline-concordant treatment among Medicaid enrollees with breast and colorectal cancer [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A140.