Abstract
Background: Trends in the care of patients with cancer are monitored annually by the Commission on Cancer of the American College of Surgeons. In 1991 a patient care evaluation study of breast cancer was conducted, which among other questions examined the correlation of health insurance with type or quality of care delivered for breast cancer on a national basis.
Methods: The tumor registry system of the American College of Surgeons was used to obtain data on patients with breast cancer diagnosed in 1983 and 1990. Trends in diagnosis and treatment were correlated with the type of insurance or lack of insurance.
Results: Data were obtained from hospitals in 50 states on a total of 41,651 patients. The largest number of patients were covered by Medicare. Fewer than 5% were considered medically indigent. Medically indigent patients presented with higher stage disease and did not participate in a trend toward downstaging, which occurred between the two study years. The treatment of medically indigent patients appeared to be appropriate and comparable with better insured patients. Insurance type (health maintenance organization vs. private) did not affect stage, treatment, or outcome. Decisions to use controversial therapies, such as chemotherapy for stage I disease, did not appear to be financially driven.
Conclusion: A nationwide pattern of care study for breast cancer indicates that medically indigent patients present with more advanced disease compared with better insured patients, but once the diagnosis is made, treatment and outcome have little to do with insurance type.
Similar content being viewed by others
References
Nemoto T, Vana J, Bedwanni RN, Baker HW, McGregor FH, Murphy GP. Management and survival of female breast cancer. Results of a national survey by the American College of Surgeons.Cancer 1980;45:2917–24.
Wilson RE, Donegan WL, Mettlin C, Smart CR, Murphy GP. The 1982 national survey of carcinoma of the breast in the United States by the American College of Surgeons.Surg Gynecol Obstet 1984;1509:309–18.
Manual for staging of cancer, 1988. 3rd. ed.
Coates RJ, Bransfield DD, Wesley M, et al. Differences between black and white women with breast cancer in time from symptom recognition to medical consultation.J Natl Cancer Inst 1992;84:938–50.
Swanson GM, Satariano ER, Satariano WA, Threaft BA. Racial differences in the early detection of breast cancer in metropolitan Detroit, 1978–1987.Cancer 1990;66:1297–301.
Hand R, Sener S, Imperato J, Chmiel JS, Sylvester J, Fremgen A. Hospital variables associated with quality of care for breast cancer patients.JAMA 1991;266:3429–32.
Walker AP, Neal L, Ausman RK, Whipple J, Doherty B. Per capita income in breast cancer patients.J Natl Med Assoc 81:1065–8.
Diehr P, Yergan J, Chu J, et al. Treatment modality and quality differences for black and white breast cancer patients treated in community hospitals.Med Care 1989;27:942–54.
Ayanian JZ, Kohler BA, Ahe T, Epstein AM. The relationship between health coverage and clinical outcomes among women with breast cancer.N Engl J Med 1993;329:326–31.
Osteen RT, Cady B, Chmiel JS, et al. 1991 National Survey of Carcinoma of the Breast by the Commission on Cancer.Surg Gynecol Obstet 1994;178:213–9.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Osteen, R.T., Winchester, D.P., Hussey, D.H. et al. Insurance coverage of patients with breast cancer in the 1991 Commission on Cancer patient care evaluation study. Annals of Surgical Oncology 1, 462–467 (1994). https://doi.org/10.1007/BF02303610
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02303610