Gynecologic cancer outcomes in the elderly poor: A population‐based study. Issue 20 (31st July 2015)

• Record Type: Journal Article
• Authors: Doll, Kemi M.; Meng, Ke; Basch, Ethan M.; Gehrig, Paola A.; Brewster, Wendy R.; Meyer, Anne‐Marie
• Is Part Of: Cancer. Volume 121:Issue 20(2015)
• Page Start: 3591
• Page End: 3599
• Publication Date: 2015-07-31
• Subjects: Cancer -- Periodicals; Cancer -- Cytopathology -- Periodicals; 616.99405
• DOI: 10.1002/cncr.29541
• Languages: English
• ISSNs: 0008-543X

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="cncr29541-sec-0001" sec-type="section"> <title>BACKGROUND</title> <p>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.</p> </sec> <sec id="cncr29541-sec-0002" sec-type="section"> <title>METHODS</title> <p>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.</p> </sec> <sec id="cncr29541-sec-0003" sec-type="section"> <title>RESULTS</title> <p>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.</p> </sec> <sec id="cncr29541-sec-0004" sec-type="section"> <title>CONCLUSIONS</title> <p>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. <bold><italic>Cancer</italic> 2015;121:3591–3599</bold>. © <italic>2015 American Cancer Society</italic>.</p> </sec> </abstract>