Impact of payer status on treatment of cervical cancer at a tertiary referral center

Research output: Contribution to journalArticle

Abstract

Objectives: The study aims to determine the impact of payer status on the likelihood of receiving definitive treatment for invasive cervical cancer at a tertiary medical center. Methods: All consecutive patients presenting to Johns Hopkins Hospital with a diagnosis of invasive cervical cancer between 1/1/95-12/31/08 were retrospectively identified from the tumor registry. Demographic and clinical information were abstracted from the medical record. Payer status was categorized as private, public, no insurance, or unknown. Treatment was defined as surgery, chemo-radiation, chemotherapy, radiation, or no definitive therapy. The likelihood of receiving no definitive therapy was analyzed using Pearson chi-square analysis, univariate and multivariate models. Results: A total of 306 patients were identified. Median age was 47 and 60% of patients had early stage disease at diagnosis (stages IA-IIA). Fifty-six percent of the cohort had private insurance, 34% had public insurance, and 6% had no insurance. Having no insurance was the single most significant risk factor associated with receiving no standard therapy. While 7% of privately insured and 4% of publicly insured patients did not receive definitive therapy, 16% of uninsured patients did not receive definitive treatment. In multivariate analysis controlling for age, race, stage, histology, and comorbidities, uninsured payer status was a significant and independent predictor of receiving no definitive treatment (OR 8.01, CI 1.265-50.694, p = 0.027) than patients with public insurance. Conclusions: In this study, uninsured payer status was significantly associated with a higher likelihood of not receiving standard therapy for cervical cancer. Additional studies are warranted to characterize specific barriers to care for this at-risk population.

Original languageEnglish (US)
Pages (from-to)324-327
Number of pages4
JournalGynecologic Oncology
Volume122
Issue number2
DOIs
StatePublished - Aug 2011

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Tertiary Care Centers
Uterine Cervical Neoplasms
Insurance
Therapeutics
Multivariate Analysis
Radiation
Medical Records
Registries
Comorbidity
Histology
Demography
Drug Therapy

Keywords

  • Access
  • Cervical cancer
  • Insurance status
  • Treatment

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology

Cite this

@article{86ab91b6977647799c0477cdeac3cf22,
title = "Impact of payer status on treatment of cervical cancer at a tertiary referral center",
abstract = "Objectives: The study aims to determine the impact of payer status on the likelihood of receiving definitive treatment for invasive cervical cancer at a tertiary medical center. Methods: All consecutive patients presenting to Johns Hopkins Hospital with a diagnosis of invasive cervical cancer between 1/1/95-12/31/08 were retrospectively identified from the tumor registry. Demographic and clinical information were abstracted from the medical record. Payer status was categorized as private, public, no insurance, or unknown. Treatment was defined as surgery, chemo-radiation, chemotherapy, radiation, or no definitive therapy. The likelihood of receiving no definitive therapy was analyzed using Pearson chi-square analysis, univariate and multivariate models. Results: A total of 306 patients were identified. Median age was 47 and 60{\%} of patients had early stage disease at diagnosis (stages IA-IIA). Fifty-six percent of the cohort had private insurance, 34{\%} had public insurance, and 6{\%} had no insurance. Having no insurance was the single most significant risk factor associated with receiving no standard therapy. While 7{\%} of privately insured and 4{\%} of publicly insured patients did not receive definitive therapy, 16{\%} of uninsured patients did not receive definitive treatment. In multivariate analysis controlling for age, race, stage, histology, and comorbidities, uninsured payer status was a significant and independent predictor of receiving no definitive treatment (OR 8.01, CI 1.265-50.694, p = 0.027) than patients with public insurance. Conclusions: In this study, uninsured payer status was significantly associated with a higher likelihood of not receiving standard therapy for cervical cancer. Additional studies are warranted to characterize specific barriers to care for this at-risk population.",
keywords = "Access, Cervical cancer, Insurance status, Treatment",
author = "Kimberly Levinson and Bristow, {Robert E.} and Donohue, {Pamela Kimzey} and Kanarek, {Norma F} and Trimble, {Cornelia L}",
year = "2011",
month = "8",
doi = "10.1016/j.ygyno.2011.04.038",
language = "English (US)",
volume = "122",
pages = "324--327",
journal = "Gynecologic Oncology",
issn = "0090-8258",
publisher = "Academic Press Inc.",
number = "2",

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T1 - Impact of payer status on treatment of cervical cancer at a tertiary referral center

AU - Levinson, Kimberly

AU - Bristow, Robert E.

AU - Donohue, Pamela Kimzey

AU - Kanarek, Norma F

AU - Trimble, Cornelia L

PY - 2011/8

Y1 - 2011/8

N2 - Objectives: The study aims to determine the impact of payer status on the likelihood of receiving definitive treatment for invasive cervical cancer at a tertiary medical center. Methods: All consecutive patients presenting to Johns Hopkins Hospital with a diagnosis of invasive cervical cancer between 1/1/95-12/31/08 were retrospectively identified from the tumor registry. Demographic and clinical information were abstracted from the medical record. Payer status was categorized as private, public, no insurance, or unknown. Treatment was defined as surgery, chemo-radiation, chemotherapy, radiation, or no definitive therapy. The likelihood of receiving no definitive therapy was analyzed using Pearson chi-square analysis, univariate and multivariate models. Results: A total of 306 patients were identified. Median age was 47 and 60% of patients had early stage disease at diagnosis (stages IA-IIA). Fifty-six percent of the cohort had private insurance, 34% had public insurance, and 6% had no insurance. Having no insurance was the single most significant risk factor associated with receiving no standard therapy. While 7% of privately insured and 4% of publicly insured patients did not receive definitive therapy, 16% of uninsured patients did not receive definitive treatment. In multivariate analysis controlling for age, race, stage, histology, and comorbidities, uninsured payer status was a significant and independent predictor of receiving no definitive treatment (OR 8.01, CI 1.265-50.694, p = 0.027) than patients with public insurance. Conclusions: In this study, uninsured payer status was significantly associated with a higher likelihood of not receiving standard therapy for cervical cancer. Additional studies are warranted to characterize specific barriers to care for this at-risk population.

AB - Objectives: The study aims to determine the impact of payer status on the likelihood of receiving definitive treatment for invasive cervical cancer at a tertiary medical center. Methods: All consecutive patients presenting to Johns Hopkins Hospital with a diagnosis of invasive cervical cancer between 1/1/95-12/31/08 were retrospectively identified from the tumor registry. Demographic and clinical information were abstracted from the medical record. Payer status was categorized as private, public, no insurance, or unknown. Treatment was defined as surgery, chemo-radiation, chemotherapy, radiation, or no definitive therapy. The likelihood of receiving no definitive therapy was analyzed using Pearson chi-square analysis, univariate and multivariate models. Results: A total of 306 patients were identified. Median age was 47 and 60% of patients had early stage disease at diagnosis (stages IA-IIA). Fifty-six percent of the cohort had private insurance, 34% had public insurance, and 6% had no insurance. Having no insurance was the single most significant risk factor associated with receiving no standard therapy. While 7% of privately insured and 4% of publicly insured patients did not receive definitive therapy, 16% of uninsured patients did not receive definitive treatment. In multivariate analysis controlling for age, race, stage, histology, and comorbidities, uninsured payer status was a significant and independent predictor of receiving no definitive treatment (OR 8.01, CI 1.265-50.694, p = 0.027) than patients with public insurance. Conclusions: In this study, uninsured payer status was significantly associated with a higher likelihood of not receiving standard therapy for cervical cancer. Additional studies are warranted to characterize specific barriers to care for this at-risk population.

KW - Access

KW - Cervical cancer

KW - Insurance status

KW - Treatment

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