Cathy J. Bradley

Disparities in cancer diagnosis and survival

Concern has been raised over the disproportionate cancer mortality among minority and low‐income persons. The current study examined differences in disease stage at the time of diagnosis and subsequent survival for patients who are medically indigent compared with the rest of the population of cancer patients in Michigan.

Productivity Costs of Cancer Mortality in the United States: 2000–2020

BACKGROUND A model that predicts the economic benefit of reduced cancer mortality provides critical information for allocating scarce resources to the interventions with the greatest benefits. METHODS We developed models using the human capital approach, which relies on earnings as a measure of productivity, to estimate the value of productivity lost as a result of cancer mortality. The base model aggregated age- and sex-specific data from four primary sources: 1) the US Bureau of the Census, 2) US death certificate data for 1999-2003, 3) cohort life tables from the Berkeley Mortality Database for 1900-2000, and 4) the Bureau of Labor Statistics Current Population Survey. In a model that included costs of caregiving and household work, data from the National Human Activity Pattern Survey and the Caregiving in the U.S. study were used. Sensitivity analyses were performed using six types of cancer assuming a 1% decline in cancer mortality rates. The values of forgone earnings for employed individuals and imputed forgone earnings for informal caregiving were then estimated for the years 2000-2020. RESULTS The annual productivity cost from cancer mortality in the base model was approximately

Cancer, medicaid enrollment, and survival disparities

115.8 billion in 2000; the projected value was

Late stage cancers in a medicaid-insured population

147.6 billion for 2020. Death from lung cancer accounted for more than 27% of productivity costs. A 1% annual reduction in lung, colorectal, breast, leukemia, pancreatic, and brain cancer mortality lowered productivity costs by

Observation interval for evaluating the costs of surgical interventions for older women with a new diagnosis of breast cancer.

814 million per year. Including imputed earnings lost due to caregiving and household activity increased the base model total productivity cost to

Estimates and Projections of Value of Life Lost From Cancer Deaths in the United States

232.4 billion in 2000 and to

Influence of patient-provider communication on colorectal cancer screening.

308 billion in 2020. CONCLUSIONS Investments in programs that target the cancers with high incidence and/or cancers that occur in younger, working-age individuals are likely to yield the greatest reductions in productivity losses to society.

Applying Propensity Score Methods in Medical Research: Pitfalls and Prospects

The current article examined survival for adults < 65 years old diagnosed with breast, colorectal, or lung carcinoma who were either Medicaid insured at the time of diagnosis, Medicaid insured after diagnosis, or non‐Medicaid insured.

Health Services Research and Data Linkages: Issues, Methods, and Directions for the Future

Background. Medicaid insurance promotes screening for early stage cancers. However, previous research suggests that Medicaid recipients are at risk for late stage disease. Objective. To identify differences in stage of diagnosis between cancer patients enrolled in Medicaid before versus after their disease was identified, as well as differences in diagnostic stage between Medicaid enrollees and other patients. Design. Analyses of a linked database including information from the 1996 and 1997 Michigan Cancer Registry and Medicaid enrollment files. Patients. All persons ages 25 to 64 diagnosed with incident cases of breast, cervical, colorectal, or lung cancer (n = 5852). Patients enrolled in Medicaid before their cancer diagnosis and those enrolled in the same month or after their diagnosis were identified. Main Outcome Measure. Early (in situ, local) versus late (regional, distant, invasive/unknown) cancer stage at diagnosis was modeled using multivariate logistic regression. Results. In each site of disease with the exception of breast, persons who enrolled in Medicaid after a cancer diagnosis were approximately 2 to 3 times more likely to have late stage disease compared with persons who were enrolled in Medicaid before the month of diagnosis. Odds ratios (OR) and 95% confidence intervals (C.I.) were: 1.28 (95% C.I. = 0.95, 1.67) for breast cancer, 2.96 (95% C.I. = 1.85, 4.75) for cervical cancer, 2.08 (95% C.I. = 1.30, 3.33) for colorectal cancer, and 3.40 (95% C.I. = 2.13, 5.43) for lung cancer. Relative to non-Medicaid enrollees, Medicaid enrollees were 2 to 5 times more likely to be diagnosed with late stage disease. Conclusions. Cancer patients enrolled in Medicaid after their diagnosis were disproportionately likely to have late stage disease relative to patients previously enrolled in Medicaid or non-Medicaid enrollees.

Long-Term Financial Burden of Breast Cancer: Experiences of a Diverse Cohort of Survivors Identified Through Population-Based Registries

Objective.To estimate the episodic costs of surgical treatments for breast cancer. Methods.The surgical treatment period as the 6 weeks following diagnosis is defined. Using a sample of 205 women aged 65 and older and their Medicare claim files, the cost of treatment is estimated and the progression from first to subsequent surgical procedures during the 6-week interval is demonstrated with a decision tree. Two equations are then estimated: the probability of mastectomy versus breast conserving surgery (BCS) as first surgery using Probit regression and the log of total charges using a generalized linear regression model. Results.It was found that only stage predicts the probability of mastectomy versus BCS and that 54% of women receiving BCS undergo a second surgery. Once all treatments in the initial surgical period are accounted, the difference between the adjusted cost of mastectomy alone and BCS followed by a second surgery was not statistically significant. Only a successful first BCS is statistically significantly (P <0.05) less costly than a mastectomy alone (