Breast cancer diagnosis and treatment in a safety net setting: Differences between insured and uninsured patients

Abstract

6566 Background: Despite the safety net system and many other means of providing free or low cost care to women with breast cancer, disparities in health outcomes between uninsured and insured women with breast cancer exist. In this study, we evaluate the role of health insurance on breast cancer treatments at a large safety net hospital system. Methods: From the patient population at the Massey Cancer Center at Virginia Commonwealth University Health Care System (a large regional safety net provider), we selected women ages 21 to 64 diagnosed with breast cancer between January 1999 and March 2006 (n=1,381). We used billing records to identify health insurance status of these patients. First, we compared the stage of disease and tumor size at diagnosis for women with and without insurance. Next, we compared the number of days between diagnosis and surgery and the number of days between surgery and chemotherapy initiation. Finally, we estimated the number of days it took these groups of women to complete a common adjuvant chemotherapy regimen of doxorubicin plus cyclophosphamide (AC) or doxorubicin plus cyclophosphamide followed by paclitaxel (ACT). Results: Our analysis shows that women without insurance were more likely to have more advanced cancers and correspondingly larger tumors. Uninsured women experienced considerable delays from the date of diagnosis to surgery and from surgery to chemotherapy initiation compared with insured women (21.5 and 22 days longer, respectively). Uninsured women also took significantly longer to complete adjuvant chemotherapy regimens relative to insured women (4 and 26 days for AC and ACT, respectively). Conclusions: To understand the disparities that exist in breast cancer outcomes among women with and without health insurance, we must understand the different experiences these groups of women have with treatment. In this study, uninsured women had more advanced cancers, and experienced considerable delays receiving and completing treatment relative to insured women. Our study demonstrates the value of health insurance in the timely provision of health care even in a safety net setting where care is guaranteed. No significant financial relationships to disclose.