Changes in initiation of adjuvant endocrine therapy for breast cancer after state health reform

Socioeconomic differences in receipt of adjuvant treatment contribute to persistent disparities in breast cancer (BCA) outcomes, including survival. Adjuvant endocrine therapy (AET) substantially reduces recurrence risk and is recommended by clinical guidelines for nearly all women with hormone rece...

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Bibliographic Details
Published in:BMC cancer 2021-05, Vol.21 (1), p.487-9, Article 487
Main Authors: Eom, Kirsten Y, van Londen, G J, Li, Jie, Dahman, Bassam, Bradley, Cathy, Sabik, Lindsay M
Format: Article
Language:English
Subjects:
Adjuvant endocrine therapy
Adjuvant treatment
Adult
Age Factors
Breast cancer
Breast Neoplasms - chemistry
Breast Neoplasms - drug therapy
Cancer
Cancer registry
Care and treatment
Chemotherapy, Adjuvant
Endocrine therapy
Estrogen receptors
Female
Health care policy
Health Care Reform
Health insurance
Hormone therapy
Humans
Income
Influence
Insurance Coverage
Laws, regulations and rules
Likelihood Functions
Massachusetts
Massachusetts health reform
Medical care
Metastases
Middle Aged
Neoplasm Recurrence, Local - prevention & control
Patients
Receptors, Estrogen
Regression Analysis
Socioeconomic Factors
Statistics
Utilization
Womens health
Young Adult
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Summary:Socioeconomic differences in receipt of adjuvant treatment contribute to persistent disparities in breast cancer (BCA) outcomes, including survival. Adjuvant endocrine therapy (AET) substantially reduces recurrence risk and is recommended by clinical guidelines for nearly all women with hormone receptor-positive non-metastatic BCA. However, AET use among uninsured or underinsured populations has been understudied. The health reform implemented by the US state of Massachusetts in 2006 expanded health insurance coverage and increased the scope of benefits for many with coverage. This study examines changes in the initiation of AET among BCA patients in Massachusetts after the health reform. We used Massachusetts Cancer Registry data from 2004 to 2013 for a sample of estrogen receptor (ER)-positive BCA surgical patients aged 20-64 years. We estimated multivariable regression models to assess differential changes in the likelihood initiating AET after Massachusetts health reform by area-level income, comparing women from lower- and higher-income ZIP codes in Massachusetts. There was a 5-percentage point (p-value
ISSN:1471-2407
1471-2407
DOI:10.1186/s12885-021-08149-0