Does regionalization of initial breast cancer care delay time to surgery? Cancer 2025 May 15;131(10):e35895
Date
05/09/2025Pubmed ID
40344207DOI
10.1002/cncr.35895Scopus ID
2-s2.0-105004695391 (requires institutional sign-in at Scopus site) 1 CitationAbstract
BACKGROUND: By leveraging a natural experiment afforded by New York's 2009 policy restricting Medicaid reimbursement for breast cancer surgery at low-volume hospitals, this study examined the effect of regionalization on time from breast cancer diagnosis to initial upfront surgery.
METHODS: By using a linked data set merging New York Cancer Registry and New York facilities' discharge data, women with stage I-III incident breast cancer during the pre- (2004-2008) and postpolicy (2010-2013) periods were identified. Multivariable difference-in-difference-in-differences models estimated the policy effect on the probability of experiencing delayed care (>60 days) between diagnosis and initial surgery.
RESULTS: Among 71,135 women, 12% had Medicaid coverage. Women treated in postpolicy years (p < .001 relative to prepolicy) and Medicaid beneficiaries (p < .001 relative to non-Medicaid patients) were more likely to experience delayed care. Non-Medicaid beneficiaries had a 12.6% probability of delayed care postpolicy (compared to 8.8% prepolicy), whereas Medicaid beneficiaries had a 21% probability of delayed care postpolicy (compared to 14.5% prepolicy). Although these increases were not statistically different between the Medicaid and non-Medicaid groups as a whole, which indicates no overall policy effect, Medicaid beneficiaries in nonurban areas were more likely to experience delayed care after the policy implementation (p = .04).
CONCLUSIONS: Regionalization of breast cancer care in New York did not lead to a significant overall decrease in access to timely surgical care. Regionalization of care may be a promising approach to improving breast cancer outcomes. However, the potential impact on nonurban and other vulnerable populations must be carefully considered to prevent exacerbating disparities in access to care.
Author List
Yen TWF, Nattinger AB, Bickell NA, Schymura MJ, McGinley EL, Pezzin LEAuthors
Emily L. McGinley Biostatistician III in the Center for Advancing Population Science department at Medical College of WisconsinAnn B. Nattinger MD, MPH Associate Provost, Professor in the Medicine department at Medical College of Wisconsin
Liliana Pezzin PhD, JD Director, Professor in the Institute for Health and Humanity department at Medical College of Wisconsin
Tina W F Yen MD, MS Professor in the Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdultAged
Breast Neoplasms
Female
Health Services Accessibility
Humans
Mastectomy
Medicaid
Middle Aged
New York
Registries
Time-to-Treatment
United States
