Breast cancer survival and treatment in health maintenance organization and fee-for-service settings.
ABSTRACT Enrollment in health maintenance organizations (HMOs) has increased rapidly during the past 10 years, reflecting a growing emphasis on health care cost containment. To determine whether there is a difference in the treatment and outcome for female patients with breast cancer enrolled in HMOs versus a fee-for-service setting, we compared the 10-year survival and initial treatment of patients with breast cancer enrolled in both types of plans.
With the use of tumor registries covering the greater San Francisco-Oakland and Seattle-Puget Sound areas, respectively, we obtained information on the treatment and outcome for 13,358 female patients with breast cancer, aged 65 years and older, diagnosed between 1985 and 1992. We linked registry information with Medicare data and data from the two large HMOs included in the study. We compared the survival and treatment differences between HMO and fee-for-service care after adjusting for tumor stage, comorbidity, and sociodemographic characteristics.
In San Francisco-Oakland, the 10-year adjusted risk ratio for breast cancer deaths among HMO patients compared with fee-for-service patients was 0.71 (95% confidence interval [CI] = 0.59-0.87) and was comparable for all deaths. In Seattle-Puget Sound, the risk ratio for breast cancer deaths was 1.01 (95% CI = 0.77-1.33) but somewhat lower for all deaths. Women enrolled in HMOs were more likely to receive breast-conserving surgery than women in fee-for-service (odds ratio = 1.55 in San Francisco-Oakland; 3.39 in Seattle). HMO enrollees undergoing breast-conserving surgery were also more likely to receive adjuvant radiotherapy (San Francisco-Oakland odds ratio = 2.49; Seattle odds ratio = 4.62).
Long-term survival outcomes in the two prepaid group practice HMOs in this study were at least equal to, and possibly better than, outcomes in the fee-for-service system. In addition, the use of recommended therapy for early stage breast cancer was more frequent in the two HMOs.
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ABSTRACT: Practical models of ways to enhance service delivery are sorely needed to help close the gap between research and practice. An evidenced-based model of chronic-illness management is shown to apply equally to preventive interventions. Successful examples of prevention programs in cancer screening and counseling for health behavior change illustrate the utility of the model for prevention and across different types of health care organizations. Although there are some important differences between interventions required for chronic disease management and prevention, there are a greater number of common factors. They share the need to alter reactive acute-care-oriented practice to accommodate the proactive, planned, patient-oriented longitudinal care required for both prevention and chronic care.Milbank Quarterly 02/2001; 79(4):579-612, iv-v.
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ABSTRACT: Breast cancer is the most frequent tumor among Saudi women, accounting to 19.8% of female cancers. The present study was conducted to determine 5-year survival for all cases of invasive breast cancer that occurred during 1994-96 in the province of Riyadh (n=316). The overall observed survival probability of the study population at 1, 3 and 5 years was 93.9%, 79.2% and 59.6%, respectively. The 5 year survivals for the younger (< 40 years), older (50 + years) and 40-49 years patients were 60.6%, 51.6% and 69.2% respectively, the differences not reaching statistical significance. While there was not a great deal of variation in the 5-year survival between cases with regional (55.6%), distant metastasis (57.6%) and extent of disease unknown (56.7%) cases, localized (67.5%) cases had a clearly better prognosis. An increased but not significant hazard was seen for the cases with regional and distant metastasis disease, 1.40 and 1.11 respectively, compared to localized cases. The 5-year survival for duct carcinomas (62.8%) was greater than for adenocarcinomas (55.6%) and lobular carcinomas (50.0%).Asian Pacific journal of cancer prevention: APJCP 6(1):72-6.
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ABSTRACT: Women at risk of being undertreated for breast cancer include women who are older, from minority groups, from lower socioeconomic backgrounds, and those without health insurance or insured by Medicaid. Recent reviews of the cancer care experience of medically underserved populations indicate that breast cancer care may be even less optimal for these populations than the majority of women. These are the same women who may experience difficulty obtaining access to medical care once they are diagnosed with breast cancer. Indirect proof of problems with access is manifested as higher recurrence rates of breast cancer and differences in breast cancer-specific survival among medically underserved women. Multiple factors have been shown to affect access to medical care, and therefore quality of care, including patient-level factors, provider-level factors, and health system factors. This article reviews the current state of these factors in explaining breast cancer care in medically underserved women.The Breast Journal 01/2004; 10(1):2-5. DOI:10.1111/j.1524-4741.2004.09511.x