Background: Lack of insurance has been identified as a key barrier to timely adjuvant chemotherapy, but this evidence may not be generalizable to public hospitals, where care is provided regardless of insurance status. Therefore, we aimed to assess whether insurance status is associated with delayed adjuvant chemotherapy among underserved women with stages I-III breast cancer treated at an urban public hospital.
Methods: We used data from the JPS Center for Cancer Care institutional registry (accredited by the Commission on Cancer). This center is part of an urban public hospital network that serves Tarrant County, TX (population >2 million) and is a primary source of care for underserved individuals. Our eligible population included females aged ≥18 years diagnosed with stages I-III primary breast cancer between 2008 and 2015 and received surgery (lumpectomy or mastectomy) plus adjuvant chemotherapy as first course treatment. Treatment delay was defined as >120 days from diagnosis to adjuvant chemotherapy. We estimated risk ratios (RR), risk differences (RD), and corresponding 95% confidence limits (CL) for the association between insurance status and treatment delay, adjusting for age, race/ethnicity, marital status, and household income.
Results: Our study population comprised 223 female breast cancer patients, of whom 55% were aged <55 years, 29% were non-Hispanic Black, 34% were Hispanic, 51% were uninsured, and 40% were publicly insured. The median time to adjuvant chemotherapy was 98 days (interquartile range: 83-119). Overall, 77% initiated adjuvant chemotherapy within 120 days after diagnosis. The initiation of adjuvant chemotherapy later than 120 days was 22% among publicly insured individuals and 25% among uninsured (RR=1.1; 95% CL: 0.63, 1.8; RD=0.06; 95% CL: -0.06, 0.17).
Discussion: Our results suggest minimal differences in delayed adjuvant chemotherapy between publicly insured and uninsured breast cancer patients treated at an urban public hospital. More importantly, time to adjuvant chemotherapy in our population is only nominally longer than at National Comprehensive Cancer Network Institutions (93 days), which may be partially attributable to uninsured patients being enrolled in a hospital-based insurance assistance program. Future studies should assess whether hospital-based insurance assistance programs are similarly effective in other settings, which could have implications for reducing disparities in breast cancer outcomes.
Citation Format: Bradford E. Jackson, Yan Lu, Jolonda Bullock, Muhammad Isa, Bassam Ghabach, Rohit P. Ojha. Insurance status and delayed adjuvant chemotherapy among women with breast cancer at an urban public hospital [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B080.