title: Impact of Insurance Status on Radiation Treatment Modality Selection Among Potential Candidates for Prostate, Breast, or Gynecologic Brachytherapy.
abstract: OBJECTIVE
  The Patient Protection and Affordable Care Act looks to expand both private and Medicaid insurance. To evaluate how these changes may affect the field of radiation oncology, we evaluated the association of insurance status with the use of brachytherapy in cancers for which this treatment technique is used.
  
  
  METHODS
  A total of 190,467 patients met the inclusion criteria, of whom 95,292 (50.0%) had breast cancer, 61,096 (32.1%) had prostate cancer, 28,194 (14.8%) had endometrial cancer, and 5885 (3.1%) had cervical cancer. A multivariate logistic regression model was used to determine the association between insurance status and receipt of brachytherapy among patients treated definitively for prostate and cervical cancer or postoperatively for breast and endometrial cancer.
  
  
  RESULTS
  The rates of non-Medicaid insurance were 49.9% (cervical), 85.3% (endometrial), 87.4% (breast), and 90.9% (prostate) (P<.001). In a logistic regression, patients who received radiation therapy were less likely to receive brachytherapy if they had Medicaid coverage (odds ratio [OR] 0.57, 95% confidence interval [CI] 0.53-0.61, P<.001) or did not have insurance coverage (OR 0.50, 95% CI 0.45-0.56, P<.001) compared with those with non-Medicaid insurance. On subset analysis, patients with Medicaid coverage or without insurance coverage were significantly less likely to receive brachytherapy than were those with non-Medicaid insurance for all 4 sites, except for patients with endometrial cancer.
  
  
  CONCLUSIONS
  Despite being a cost-effective treatment modality, brachytherapy is less often used in the definitive or postoperative management of cancer in patients with Medicaid coverage or without insurance. Upcoming health policy changes resulting in the expansion of private insurance and Medicaid will likely increase access to and demand for brachytherapy.
authors.affiliation: Baylor College of Medicine, Houston, Texas.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Grant
authors.affiliation: Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas.
authors.forename: Gary V
authors.initials: GV
authors.lastname: Walker
authors.affiliation: Department of Radiation Oncology, The University of Chicago, Chicago, Illinois.
authors.forename: Matthew
authors.initials: M
authors.lastname: Koshy
authors.affiliation: Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas.
authors.forename: Simona F
authors.initials: SF
authors.lastname: Shaitelman
authors.affiliation: Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas.
authors.forename: Ann H
authors.initials: AH
authors.lastname: Klopp
authors.affiliation: Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Frank
authors.affiliation: Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Pugh
authors.affiliation: Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas.
authors.forename: Pamela K
authors.initials: PK
authors.lastname: Allen
authors.affiliation: Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas. Electronic address: UMahmood@mdanderson.org.
authors.forename: Usama
authors.initials: U
authors.lastname: Mahmood
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000706:statistics & numerical data*; D001943:Breast Neoplasms / Q000532:radiotherapy*; D016001:Confidence Intervals; D016889:Endometrial Neoplasms / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D017057:Medically Uninsured / Q000706:statistics & numerical data; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D012044:Regression Analysis; D018426:SEER Program; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy*; D055815:Young Adult