Outcomes of Curable Cancers in Vulnerable Populations

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DESCRIPTION (provided by applicant): A number of cancers, including cancer of the testis; Hodgkins and non-Hodgkins lymphoma; early- stage breast, colorectal, lung, and urinary bladder cancer; early-stage melanoma; and pediatric malignancies in adults are considered "curable", which we define as 5-year survival without relapse. While high rates of cure have been reported in the population at large, little is known about whether these rates compare uniformly across subgroups of the population; and if so, which factors contribute to lower cure rates. In the proposed studies, which focus on adults 20-50 years of age, we aim to assess survival from these cancers in the population of Ohio overall, and in the Medicaid population in particular. Medicaid beneficiaries constitute a disadvantaged subgroup of the population. This is because in addition to socioeconomic vulnerabilities, adult beneficiaries suffer from disabling physical and/or mental ailments. An exception to this is low-income women of childbearing age seeking Medicaid coverage for maternity care. In studies accounting for the entire population in the state of Ohio, we will examine variations in survival by demographic attributes, as well as Medicaid status, additional socioeconomic indicators, and county of residence. When focusing on Medicaid beneficiaries, and given the availability of claims data for that population, we will examine the likelihood of cure in the presence or absence of mental and/or physical comorbid conditions. The proposed studies will use a unique population-based database, which we will develop by linking records from the Ohio Cancer Incidence Surveillance System (OCISS), with the state Medicaid enrollment and claims files, and data from the U.S. Census. Death-related variables, available through the OCISS files, originate from the National Death Index. By identifying differentials in survival and cure rates across subgroups of the population, these studies will provide a foundation for future research endeavors aimed at identifying the specific factors contributing to such disparities. In addition, because these cancers have been rarely examined in the context of health services and disparities-related research, the proposed studies will provide an opportunity to assess methodological issues and potential difficulties in carrying out comparable studies at a larger scale and in other settings. Project Narrative: A number of cancers, including cancer of the testis; Hodgkins and non-Hodgkins lymphoma; early- stage breast, colorectal, lung, and urinary bladder cancer; early-stage melanoma; and pediatric malignancies in adults are considered "curable", which we define as 5-year survival without relapse. The proposed studies aim to determine whether favorable outcomes of curable cancers are observed uniformly across subgroups of the population in Ohio. We will examine survival outcomes by Medicaid status; and among Medicaid beneficiaries, survival and cure rates will be evaluated in the presence or absence of mental and/or physical comorbid conditions.