The Uninsured are a Distinct Population in a Breast Cancer Cohort, with Unique Screening, Staging, and Outcomes.

Insurance status is a known determinant of cancer stage at diagnosis and outcome. However, insurance status can change over the course of the disease and its treatment, complicating causal analysis. Cancer registries strive to capture the insurance status of patients at diagnosis, but this is not always possible. Breast cancer poses a particular challenge for this effort, as uninsured patients become eligible for Medicaid upon the diagnosis. Thus, their insurance status may have changed from uninsured to Medicaid by the time registrars interact with treatment records. We addressed this potential blurring between categories by working with a sample of patients identified through the cancer registry of the Medical University of South Carolina to focus on determining insurance status at diagnosis whenever possible. We found that the uninsured population (32 women) was larger than the Medicaid-covered population (22 women) in a sample of patients in South Carolina, a state that did not accept the Medicaid expansion. Compared with women who carried any type of insurance, uninsured women were much more likely to find their own breast mass through palpation rather than through screening, they were diagnosed with a later stage of breast cancer at diagnosis, and their outcomes were worse. Insured women experienced significantly increased survival odds (odds ratio, 3.28) and multiple regression analysis demonstrated that the higher stages seen in uninsured women largely accounted for the poorer outcomes. These findings suggest that more research is needed to define the characteristics and disease courses unique to the breast cancer population lacking insurance prior to diagnosis.

Analysis of the National Cancer Data Base to Describe Treatment Trends in Stage IV Oral Cavity and Pharyngeal Cancers in the United States, 1998-2012.

Treatment recommendations for head and neck cancers have evolved over the last several decades, with a particularly clear shift in 2004 toward use of chemotherapy in late-stage patients. This study examines the national trends in treatment combinations for patients with stage IV oral cavity and pharyngeal cancer between 1998 and 2012 using the National Cancer Data Base (NCDB). Our analysis demonstrates that chemotherapy was widely integrated into the treatment plans for this population following 2004, confirming that recommendations were successfully translated into practice. Stage IV patients treated after this shift in treatment experienced higher 5-year survival rates compared to patients treated prior to the adoption of increased chemotherapy usage. We also examined the patient population for other changes over time and found that smaller primary tumors became more common and that 2 primary sites (base of tongue and tonsil) came to represent a larger percentage of the patient population; these changes may also contribute to a rising survival rate. Patients receiving the recommended trimodal therapy of surgery, radiation, and chemotherapy were found to be more geographically widespread over time, suggesting a penetrance of the recommendations into the medical system across the country.

A primer on molecular biology for certified tumor registrars.

Certified tumor registrars (CTRs) are expected to have expertise in cancer staging, treatment, and patient followup and an overall knowledge of the cancer disease process. As medicine becomes more personalized, the prognosis for individual cancer patients is beginning to include more molecular markers, and CTRs are being asked to record these results along with traditional anatomic information about the disease. Molecular markers, also called biomarkers, are measured using a variety of techniques, including fluorescent in situ hybridization (FISH), immunohistochemistry (IHC), enzyme-linked immunosorbent assay (ELISA), and reverse transcription polymerase chain reaction (RT-PCR). This primer will provide an overview of these techniques so that CTRs can more efficiently search medical records for information and more accurately record these data items into abstracting templates.