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Gynecologic cancer outcomes in the elderly poor: A population‐based study
Author(s) -
Doll Kemi M.,
Meng Ke,
Basch Ethan M.,
Gehrig Paola A.,
Brewster Wendy R.,
Meyer AnneMarie
Publication year - 2015
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.29541
Subject(s) - medicine , hazard ratio , odds ratio , population , gynecology , confidence interval , obstetrics , cervical cancer , uterine cancer , cancer , cancer registry , vulvar cancer , medicaid , health care , environmental health , economics , economic growth
BACKGROUND Adults aged ≥65 years who are dually enrolled in Medicare and Medicaid are an at‐risk group in health care. However, to the best of the authors' knowledge, the outcomes of women with gynecologic cancers in this population are unknown. METHODS The current study was a population‐based cohort study of North Carolina state cancer registry cases of uterine, ovarian, cervical, and vulvar/vaginal cancers (2003‐2009), with linked enrollment in Medicare and state Medicaid. Outcomes of all‐cause mortality and stage of disease at the time of diagnosis were analyzed as a function of enrollment status using multivariate analysis and survival curves. RESULTS Of 4522 women aged ≥65 years (3702 of whom were enrolled in Medicare [82%] and 820 of whom were dually enrolled [18%]), there were 2286 cases of uterine (51%), 1587 cases of ovarian (35%), 302 cases of cervical (7%), and 347 cases of vulvar/vaginal (8%) cancers. Dual enrollees had increased all‐cause mortality overall (adjusted hazard ratio [aHR], 1.34; 95% confidence interval [95% CI], 1.19‐1.49), and within each cancer site (uterine: aHR, 1.22 [95% CI, 1.02‐1.47]; ovarian: aHR, 1.25 [95% CI, 1.05‐1.49]; cervical: aHR, 1.34 [95% CI, 0.96‐1.87]; and vulvar/vaginal: aHR, 1.93 [95% CI, 1.36‐2.72]). Increased odds of advanced‐stage disease at the time of diagnosis among dual enrollees was only present in patients with uterine cancer (adjusted odds ratio, 1.38; 95% CI, 1.06‐1.79). Stratified survival curves demonstrated the strongest disparities among women with early‐stage uterine and early‐stage vulvar/vaginal cancers. CONCLUSIONS Women aged ≥65 years who were dually enrolled in Medicare and Medicaid were found to have an overall 34% increase in all‐cause mortality after diagnosis with a gynecologic cancer compared with the non‐dually enrolled Medicare population. Women with early‐stage uterine and vulvar/vaginal cancers appeared to have the most disparate outcomes. Because these malignancies are generally curable, they have the most potential for benefit from targeted interventions. Cancer 2015;121:3591–3599 . © 2015 American Cancer Society .