Redesigning the health system has
been recognized as a priority to
improve quality and achieve value
in health care. In fact, the value-based approach to health care
quality improvement has immediate
implications for reducing inequalities
in breast cancer care and improving
outcomes. Unfortunately, the burden
of cancer is often greater for the poor
and underinsured patient population.
Issues stem from limited access,
lack of resources, marginalization,
and social indifference.
Ideally, our nation’s health care
system would guarantee that all
breast cancer patients could access
appropriate care and would receive
this care in a timely fashion. This
change begins with improving
awareness of the existing deficiencies
in our nation’s health care system
and adopting the social will to truly
transform care. Just as evidence-based medicine has improved
clinical decision making in patient
care, evidence-based policy should
be used to inform decisions about
health care reform in order to
create a system that will benefit the
entire population. The evidence
indicates that eliminating financial
barriers and improving access to
care will improve the health of
individuals with or at risk for breast
cancer. Ultimately, with all of us
working together, we can make
a difference for our patients. ♦
1. Sprague BL, Trentham-Dietz A, Gangnon RE, et al. Socioeconomic status and
survival after an invasive breast cancer diagnosis. Cancer. 2011;117( 7):1542-1551.
2. Feinglass J, Rydzewski N, Yang A. The socioeconomic gradient in all-cause
mortality for women with breast cancer: Findings from the 1998 to 2006
National Cancer Data Base with follow-up through 2011. Ann Epidemiol.
2015; 25( 8):549-555.
3. Byers TE, Wolf HJ, Bauer KR, et al. The impact of socioeconomic status on
survival after cancer in the United States: Findings from the National Program
of Cancer Registries Patterns of Care Study. Cancer. 2008;113( 3):582-591.
4. Cross CK, Harris J, Recht A. Race, socioeconomic status, and breast carcinoma
in the U.S: What have we learned from clinical studies. Cancer. 2002; 95( 9):1988-
5. Coburn N, Fulton J, Pearlman DN, Law C, DiPaolo B, Cady B. Treatment
variation by insurance status for breast cancer patients. Breast J. 2008; 14( 2):128-
6. Amini A, Jones BL, Yeh N, et al. Disparities in disease presentation in the
four screenable cancers according to health insurance status. Public Health.
7. Yabroff KR, Lund J, Kepka D, Mariotto A. Economic burden of cancer in the
United States: Estimates, projections, and future research. Cancer Epidemiol
Biomarkers Prev. 2011; 20( 10):2006-2014.
8. Fenn KM, Evans SB, McCorkle R, et al. Impact of financial burden of cancer
on survivors’ quality of life. J Oncol Pract. 2014; 10( 5):332-338.
9. Blumen H, Fitch K, Polkus V. Comparison of treatment costs for breast cancer,
by tumor stage and type of service. Am Health Drug Benefits. 2016; 9( 1): 23-32.
10. Berkowitz N, Gupta S, Silberman G. Estimates of the lifetime direct costs of
treatment for metastatic breast cancer. Value Health. 2000; 3( 1): 23-30.
11. Campbell JD, Ramsey SD. The costs of treating breast cancer in the U.S.:
A synthesis of published evidence. Pharmacoeconomics. 2009; 27( 3):199-209.
12. Ayanian JZ, Kohler BA, Abe T, Epstein AM. The relation between health
insurance coverage and clinical outcomes among women with breast cancer.
N Engl J Med. 1993;329( 5):326-331.
13. Ward EM, Fedewa SA, Cokkinides V, Virgo K. The association of insurance
and stage at diagnosis among patients aged 55 to 74 years in the national
cancer database. Cancer J. 2010; 16( 6):614-621.
14. Blumenthal D, Collins S. Where both the ACA and AHCA fall short, and what
the health insurance market really needs. Harvard Business Review. March 21,
2017. Available at: https://hbr.org/2017/03/where-both-the-aca-and-ahca-fall-
short-and-what-the-health-insurance-market-really-needs. Accessed August 21,
15. Han X, Zhu S, Tian Y, Kohler BA, Jemal A, Ward EJ. Insurance status and
cancer stage at diagnosis prior to the Affordable Care Act in the United States.
J Registry Manag. 2016; 41( 3):143-151.
16. Silva A, Molina Y, Hunt B, Markossian T, Saiyed N. Potential impact of the
Affordable Care Act’s preventive services provision on breast cancer stage:
A preliminary assessment. Cancer Epidemiol. June 9, 2017 [Epub ahead of print].
NCDB CANCER BYTES
Ideally, our nation’s health care system would
guarantee that all breast cancer patients
could access appropriate care and would
receive this care in a timely fashion.