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Grant Details

Grant Number: 5R01CA131847-05 Interpret this number
Primary Investigator: Schrag, Deborah
Organization: Dana-Farber Cancer Inst
Project Title: Cancer Care Delivery in Medicaid
Fiscal Year: 2012
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Abstract

DESCRIPTION (provided by applicant): Shortcomings in cancer care disproportionately affect minority group members and contribute to racial and ethnic disparities in cancer mortality. Many of the nearly 15 million US adults insured by Medicaid are Black or Hispanic and therefore, evaluating cancer care delivery in the context of these state health insurance programs is a logical strategy to identify the sources of disparities. By merging Medicaid enrollment and claims files with tumor registry data from New York and California, 2 states with large ethnically diverse populations and many Medicaid enrollees, we seek to identify how access to safety net health insurance and race/ethnicity intersect with common cancer diagnoses. The overarching questions we will address are: Where are there opportunities for decreasing the cancer burden for the poor? Does cancer care delivery in Medicaid achieve reasonable quality benchmarks? Do racial disparities in treatment persist within Medicaid? Specifically, we will evaluate aspects of care we understand well based on our team's prior work using Medicare-registry linked data: 1) Stage distribution at diagnosis, a marker for cancer severity and access to medical care; 2) Cancer surgery and the receipt of complex operations at experienced hospitals with high procedure volume; and, 3) Adjuvant radiation and chemotherapy treatments for cancers where these interventions improve outcomes. Analyses will focus on common solid tumors among two groups of Medicaid enrollees: adults aged 21-64 and the elderly aged 65+ dually enrolled in Medicare. We will evaluate care patterns for Medicaid patients and where data permit, compare them to patterns for otherwise similar persons not covered by Medicaid. Specifically, for each important aspect of cancer care we will also measure racial/ethnic disparities within the Medicaid program and test our hypothesis that they are minimized for patients with long term enrollment prior to diagnosis. More generally, this project will construct a resource for health services researchers, characterize its yield, and use it to identify and prioritize specific opportunities to improve cancer care delivery for vulnerable Americans. PUBLIC HEALTH RELEVANCE: Cancer care is not as good as it should be for all Americans. It is well known that care is sub-optimal for persons who are poor, many of whom are insured by State Medicaid programs. This study asks the question, is cancer care as good as it should be for patients who receive their health insurance from state Medicaid programs? Do patients who have long term access to Medicaid present with more advanced stage disease? Do they receive necessary treatments? Do the gaps in care on the basis of race and ethnicity exist within the Medicaid program? Is the information recorded on Medicaid claims reliable enough to identify important aspects of cancer treatment like surgery, radiation and chemotherapy? Could linkage of Medicaid enrollment and/or claims data to cancer registry data provide a framework for ongoing monitoring of quality of care? By examining data from New York and California which have large multiethnic populations and many persons living in poverty, this study will answer these questions and identify opportunities to improve cancer care delivery to poor Americans.

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Publications

Identification of potentially avoidable hospitalizations in patients with GI cancer.
Authors: Brooks GA, Abrams TA, Meyerhardt JA, Enzinger PC, Sommer K, Dalby CK, Uno H, Jacobson JO, Fuchs CS, Schrag D
Source: J Clin Oncol, 2014 Feb 20;32(6), p. 496-503.
EPub date: 2014 Jan 13.
PMID: 24419123
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Underuse of hospice care by Medicaid-insured patients with stage IV lung cancer in New York and California.
Authors: Mack JW, Chen K, Boscoe FP, Gesten FC, Roohan PJ, Weeks JC, Schymura MJ, Schrag D
Source: J Clin Oncol, 2013 Jul 10;31(20), p. 2569-79.
EPub date: 2013 Jun 3.
PMID: 23733768
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Regional variation in spending and survival for older adults with advanced cancer.
Authors: Brooks GA, Li L, Sharma DB, Weeks JC, Hassett MJ, Yabroff KR, Schrag D
Source: J Natl Cancer Inst, 2013 May 1;105(9), p. 634-42.
EPub date: 2013 Mar 12.
PMID: 23482657
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Initiation of adjuvant hormone therapy by Medicaid insured women with nonmetastatic breast cancer.
Authors: Yung RL, Hassett MJ, Chen K, Gesten FC, Roohan PJ, Boscoe FP, Sinclair AH, Schymura MJ, Schrag D
Source: J Natl Cancer Inst, 2012 Jul 18;104(14), p. 1102-5.
EPub date: 2012 Jul 6.
PMID: 22773822
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Effect of adjuvant chemotherapy on survival of patients with stage III colon cancer diagnosed after age 75 years.
Authors: Sanoff HK, Carpenter WR, Stürmer T, Goldberg RM, Martin CF, Fine JP, McCleary NJ, Meyerhardt JA, Niland J, Kahn KL, Schymura MJ, Schrag D
Source: J Clin Oncol, 2012 Jul 20;30(21), p. 2624-34.
EPub date: 2012 Jun 4.
PMID: 22665536
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Comparison of adverse events during 5-fluorouracil versus 5-fluorouracil/oxaliplatin adjuvant chemotherapy for stage III colon cancer: a population-based analysis.
Authors: Sanoff HK, Carpenter WR, Freburger J, Li L, Chen K, Zullig LL, Goldberg RM, Schymura MJ, Schrag D
Source: Cancer, 2012 Sep 1;118(17), p. 4309-20.
EPub date: 2012 Jan 31.
PMID: 22294436
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Comparative effectiveness of oxaliplatin vs non-oxaliplatin-containing adjuvant chemotherapy for stage III colon cancer.
Authors: Sanoff HK, Carpenter WR, Martin CF, Sargent DJ, Meyerhardt JA, Stürmer T, Fine JP, Weeks J, Niland J, Kahn KL, Schymura MJ, Schrag D
Source: J Natl Cancer Inst, 2012 Feb 8;104(3), p. 211-27.
EPub date: 2012 Jan 20.
PMID: 22266473
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Cancer disparities in the context of Medicaid insurance: a comparison of survival for acute myeloid leukemia and Hodgkin's lymphoma by Medicaid enrollment.
Authors: Yung RL, Chen K, Abel GA, Gesten FC, Roohan PJ, Boscoe FP, Sinclair AH, Schymura MJ, Schrag D
Source: Oncologist, 2011;16(8), p. 1082-91.
PMID: 21873583
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Building capacity to assess cancer care in the Medicaid population in New York State.
Authors: Boscoe FP, Schrag D, Chen K, Roohan PJ, Schymura MJ
Source: Health Serv Res, 2011 Jun;46(3), p. 805-20.
EPub date: 2010 Dec 15.
PMID: 21158856
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Cancer screening among patients with advanced cancer.
Authors: Sima CS, Panageas KS, Schrag D
Source: JAMA, 2010 Oct 13;304(14), p. 1584-91.
PMID: 20940384
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The heme degradation pathway is a promising serum biomarker source for the early detection of Alzheimer's disease.
Authors: Mueller C, Zhou W, Vanmeter A, Heiby M, Magaki S, Ross MM, Espina V, Schrag M, Dickson C, Liotta LA, Kirsch WM
Source: J Alzheimers Dis, 2010;19(3), p. 1081-91.
PMID: 20157261
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