The following is a summary of “Centralization of Initial Care and Improved Survival of Poor Patients With Breast Cancer,” published in the April 2023 issue of Oncology by Nattinger, et al.

For a study, researchers sought to investigate the effectiveness of a policy intervention implemented by the state of New York in 2009, which disallowed payment for breast cancer surgery for Medicaid beneficiaries receiving treatment in facilities that performed fewer than 30 breast cancer surgeries per year. The aim was to determine the impact of the policy on breast cancer mortality and overall survival among low-income women.

They identified 37,822 women with stage I-III breast cancer between 2004-2008 and 2010-2013 and linked them to NY hospital discharge data. A multivariable difference-in-differences approach was used to compare the mortality of Medicaid-insured patients with that of commercially or otherwise insured patients unaffected by the policy.

The study results showed that women treated during the post-policy years had slightly lower 5-year overall mortality than those treated before the policy was implemented. However, Medicaid patients’ survival gain was significantly larger (P = .018). In addition, women enrolled in Medicaid had a greater reduction in breast cancer-specific mortality than others (P = .005). Still, no greater reduction in other causes of death (P = .50). Adjusted breast cancer mortality among women covered by Medicaid declined from 6.6% to 4.5% post-policy. In comparison, breast cancer mortality among other women fell from 3.9% to 3.8%. Interestingly, a similar effect was not observed among New Jersey Medicaid patients with breast cancer treated during the same years.

The statewide policy discouraging initial care for breast cancer in low-volume facilities was associated with better survival for the Medicaid population targeted. Given the impressive results and prior research, they recommended that other policymakers consider implementing similar policies to improve breast cancer outcomes.

Reference: ascopubs.org/doi/full/10.1200/JCO.22.02012