Top

Published in:

Open Access 18-12-2024 | Breast Cancer | Breast Oncology

Association Between Delayed/Forgone Medical Care and Resource Utilization Among Women with Breast Cancer in the United States

Authors: Kriyana P. Reddy, BS, Kathleen Jarrell, MD, Cara Berkowitz, MD, Sarah Hulse, BA, Leisha C. Elmore, MD, MPHS, Rebecca Fishman, MD, Rachel A. Greenup, MD, MPH, Alina M. Mateo, MD, MS, Jami D. Rothman, MD, ScM, Dahlia M. Sataloff, MD, Julia C. Tchou, MD, PhD, S. Yousuf Zafar, MD, MHS, Oluwadamilola M. Fayanju, MD, MA, MPHS

Published in: Annals of Surgical Oncology | Issue 4/2025

Abstract

Background

Although high treatment costs of breast cancer care are well documented, the relationship between delayed/forgone (D/F) care and resource utilization among patients with breast cancer is unknown. This study sought to investigate the relationship between D/F care, resource use, and healthcare expenditures among patients with breast cancer.

Methods

Data on adult female patients with breast cancer were obtained from the Medical Expenditure Panel Survey to assess resource utilization and expenditures in the United States from 2007 to 2017. Weighted proportions of patients with ≥ 1 emergency department, ≥ 1 inpatient, ≥ 1 outpatient, and > 5 office-based encounters were compared between those experiencing D/F care versus those who did not using Rao-Scott adjusted chi-squared tests. Annual, per capita total, out-of-pocket, emergency department, inpatient, outpatient, office-based visit, and prescription medication expenditures were compared by using two-part econometric models.

Results

Five percent of patients with breast cancer experienced D/F care, and 42.9% of patients cited financial barriers as the primary reason for D/F care. In unweighted estimates, there were higher proportions of patients with ≥ 1 hospitalizations (37% vs. 16%, P < 0.001) among those experiencing D/F care versus those who did not. Patients with D/F care had $5372 (95% CI $35–$10,709, P = 0.04) higher per capita inpatient expenditures than patients without D/F care.

Conclusions

Delayed/forgone care is associated with increased resource utilization and healthcare spending among breast cancer patients. Further work is needed to address the root causes of D/F breast cancer care, with a view to mitigating disparate outcomes and increasing costs.

Available only for authorised users

Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA Cancer J Clin. 2023;73(1):17–48. https://doi.org/10.3322/caac.21763.CrossRefPubMed

Alkabban FM, Ferguson T. Breast cancer. StatPearls. 2023.

“National Cancer Institute.” Financial burden of cancer care. https://progressreport.cancer.gov/after/economic_burden. Accessed August 1, 2023.

Chen S, Cao Z, Prettner K, et al. Estimates and projections of the global economic cost of 29 cancers in 204 countries and territories from 2020 to 2050. JAMA Oncol. 2023;9(4):465–72. https://doi.org/10.1001/jamaoncol.2022.7826.CrossRefPubMedPubMedCentral

Gogate A, Wheeler SB, Reeder-Hayes KE, et al. Projecting the prevalence and costs of metastatic breast cancer from 2015 through 2030. JNCI Cancer Spectr. 2021;5(4):pkab63. https://doi.org/10.1093/jncics/pkab063.CrossRef

Bluethmann SM, Mariotto AB, Rowland JH. Anticipating the “silver tsunami”: prevalence trajectories and comorbidity burden among older cancer survivors in the United States. Cancer Epidemiol Biomark Prev. 2016;25(7):1029–36. https://doi.org/10.1158/1055-9965.EPI-16-0133.CrossRef

Park J, Look KA. Health care expenditure burden of cancer care in the United States. Inquiry. 2019;56:46958019880696. https://doi.org/10.1177/0046958019880696.CrossRefPubMed

Lo-Fo-Wong DN, Sitnikova K, Sprangers MA, de Haes HC. Predictors of health care use of women with breast cancer: a systematic review. Breast J. 2015;21(5):508–13. https://doi.org/10.1111/tbj.12447.CrossRefPubMed

Sun L, Legood R, Dos-Santos-Silva I, Gaiha SM, Sadique Z. Global treatment costs of breast cancer by stage: a systematic review. PLoS One. 2018;13(11):e0207993. https://doi.org/10.1371/journal.pone.0207993.CrossRefPubMedPubMedCentral

10.

Smith EC, Ziogas A, Anton-Culver H. Delay in surgical treatment and survival after breast cancer diagnosis in young women by race/ethnicity. JAMA Surg. 2013;148(6):516–23. https://doi.org/10.1001/jamasurg.2013.1680.CrossRefPubMed

11.

Husereau D, Drummond M, Augustovski F, et al. Consolidated health economic evaluation reporting standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations. BMJ. 2022;376:e067975. https://doi.org/10.1136/bmj-2021-067975.CrossRefPubMedPubMedCentral

12.

Thomas A, Valero-Elizondo J, Khera R, et al. Forgone medical care associated with increased health care costs among the U.S. Heart failure population. JACC Heart Fail. 2021;9(10):710–9. https://doi.org/10.1016/j.jchf.2021.05.010.CrossRefPubMed

13.

Kraft AD, Quimbo SA, Solon O, et al. The health and cost impact of care delay and the experimental impact of insurance on reducing delays. J Pediatr. 2009;155(2):281–5. https://doi.org/10.1016/j.jpeds.2009.02.035.CrossRefPubMedPubMedCentral

14.

Weissman JS, Stern R, Fielding SL, Epstein AM. Delayed access to health care: risk factors, reasons, and consequences. Ann Intern Med. 1991;114(4):325–31. https://doi.org/10.7326/0003-4819-114-4-325.CrossRefPubMed

15.

Financial toxicity and cancer treatment (PDQ(R)): health professional version. PDQ Cancer Information Summaries. 2002.

16.

Dieleman JL, Cao J, Chapin A, et al. US health care spending by payer and health condition, 1996–2016. JAMA. 2020;323(9):863–84. https://doi.org/10.1001/jama.2020.0734.CrossRefPubMedPubMedCentral

17.

Fleshner L, Lagree A, Shiner A, et al. Drivers of emergency department use among oncology patients in the era of novel cancer therapeutics: a systematic review. Oncologist. 2023;28(12):1020–33. https://doi.org/10.1093/oncolo/oyad161.CrossRefPubMedPubMedCentral

18.

Blumen H, Fitch K, Polkus V. Comparison of treatment costs for breast cancer, by tumor stage and type of service. Am Health Drug Benefits. 2016;9(1):23–32.PubMedPubMedCentral

19.

Allaire BT, Ekwueme DU, Guy GP Jr, et al. Medical care costs of breast cancer in privately insured women aged 18–44 years. Am J Prev Med. 2016;50(2):270–7. https://doi.org/10.1016/j.amepre.2015.08.035.CrossRefPubMedPubMedCentral

20.

Barron JJ, Quimbo R, Nikam PT, Amonkar MM. Assessing the economic burden of breast cancer in a US managed care population. Breast Cancer Res Treat. 2008;109(2):367–77. https://doi.org/10.1007/s10549-007-9650-4.CrossRefPubMed

21.

“National Center for Health Statistics.” Health insurance coverage. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/hus/topics/health-insurance-coverage.htm#:~:text=In%202019%2C%20adults%20aged%2018,17.5%25%20were%20uninsured%20in%202019. Accessed August 2, 2023.

22.

Ruggles S, Flood S, Sobek M, et al. IPUMS USA: Version 15.0 [2022 ACS Sample]. https://doi.org/10.18128/D010.V15.0.

23.

Neal RD, Allgar VL. Sociodemographic factors and delays in the diagnosis of six cancers: analysis of data from the “National survey of NHS patients: cancer.” Br J Cancer. 2005;92(11):1971–5. https://doi.org/10.1038/sj.bjc.6602623.CrossRefPubMedPubMedCentral

24.

Partridge AH, Hughes ME, Ottesen RA, et al. The effect of age on delay in diagnosis and stage of breast cancer. Oncologist. 2012;17(6):775–82. https://doi.org/10.1634/theoncologist.2011-0469.CrossRefPubMedPubMedCentral

25.

Partridge AH, Hughes ME, Warner ET, et al. Subtype-dependent relationship between young age at diagnosis and breast cancer survival. J Clin Oncol. 2016;34(27):3308–14. https://doi.org/10.1200/JCO.2015.65.8013.CrossRefPubMed

26.

Ruddy KJ, Gelber S, Tamimi RM, et al. Breast cancer presentation and diagnostic delays in young women. Cancer. 2014;120(1):20–5. https://doi.org/10.1002/cncr.28287.CrossRefPubMed

27.

Jerome-D’Emilia B, Suplee PD, Robles-Rodriguez E, D’Emilia W. The impact of delays in low-income women’s breast cancer experiences. Cancer Nurs. 2021;44(1):E43-52. https://doi.org/10.1097/NCC.0000000000000878.CrossRefPubMed

28.

Ratnapradipa KL, Jadhav S, Kabayundo J, et al. Factors associated with delaying medical care: cross-sectional study of Nebraska adults. BMC Health Serv Res. 2023;23(1):118. https://doi.org/10.1186/s12913-023-09140-0.CrossRefPubMedPubMedCentral

29.

Fayanju OM, Ren Y, Stashko I, et al. Patient-reported causes of distress predict disparities in time to evaluation and time to treatment after breast cancer diagnosis. Cancer. 2021;127(5):757–68. https://doi.org/10.1002/cncr.33310.CrossRefPubMed

30.

Grandhi GR, Valero-Elizondo J, Mszar R, et al. Association of cardiovascular risk factor profile and financial hardship from medical bills among non-elderly adults in the United States. Am J Prev Cardiol. 2020;2:100034. https://doi.org/10.1016/j.ajpc.2020.100034.CrossRefPubMedPubMedCentral

31.

Giannouchos TV, Brooks JM, Andreyeva E, Ukert B. Frequency and factors associated with foregone and delayed medical care due to COVID-19 among nonelderly US adults from August to December 2020. J Eval Clin Pract. 2022;28(1):33–42. https://doi.org/10.1111/jep.13645.CrossRefPubMed

32.

Reisinger MW, Moss M, Clark BJ. Is lack of social support associated with a delay in seeking medical care? A cross-sectional study of Minnesota and Tennessee residents using data from the behavioral risk factor surveillance system. BMJ Open. 2018;8(7):e018139. https://doi.org/10.1136/bmjopen-2017-018139.CrossRefPubMedPubMedCentral

33.

Findling MG, Blendon RJ, Benson JM. Delayed care with harmful health consequences-reported experiences from national surveys during coronavirus disease 2019. JAMA Health Forum. 2020;1(12):e201463. https://doi.org/10.1001/jamahealthforum.2020.1463.CrossRefPubMed

Title: Association Between Delayed/Forgone Medical Care and Resource Utilization Among Women with Breast Cancer in the United States
Authors: Kriyana P. Reddy, BS
Kathleen Jarrell, MD
Cara Berkowitz, MD
Sarah Hulse, BA
Leisha C. Elmore, MD, MPHS
Rebecca Fishman, MD
Rachel A. Greenup, MD, MPH
Alina M. Mateo, MD, MS
Jami D. Rothman, MD, ScM
Dahlia M. Sataloff, MD
Julia C. Tchou, MD, PhD
S. Yousuf Zafar, MD, MHS
Oluwadamilola M. Fayanju, MD, MA, MPHS
Publication date: 18-12-2024
Publisher: Springer International Publishing
Keywords: Breast Cancer
Breast Cancer
Published in: Annals of Surgical Oncology / Issue 4/2025
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-024-16586-x

ASO Author Reflections: Real-World Results of the KEYNOTE-522 Regimen to Guide Surgical Decision Making

Open Access
ASO Author Reflections

ASO Visual Abstract: Stage-Specific Tumoral Gene Expression Profiles of Black and White Patients with Colon Cancer

ASO Visual Abstract

Predictors of Bilateral Disease in Low-Risk Papillary Thyroid Cancer: Histopathologic Insights and Preoperative Ultrasonography

Open Access
Hemithyroidectomy
Endocrine Tumors

miR-484 as an “OncomiR” in Breast Cancer Promotes Tumorigenesis by Suppressing Apoptosis Genes

Breast Cancer
Translational Research

ASO Author Reflections: High Rate of Positive Surgical Margins Following Pelvic Exenteration in the USA: A Call to Action

Rectal Cancer
ASO Author Reflections

Survival After Orbital Exenteration for Primary Cutaneous Squamous Cell Carcinoma: A Retrospective Cohort Study

Open Access
Cutaneous Squamous Cell Carcinoma
Head and Neck Oncology

Mastering chronic pancreatitis pain: A multidisciplinary approach and practical solutions

Chronic Pancreatitis
On-demand webinar

Severe pain is the most common symptom of chronic pancreatitis. In this webinar, experts share the latest insights in pain management for chronic pancreatitis patients. Experts from a range of disciplines discuss pertinent cases and provide practical suggestions for use within clinical practice.

Podcast | Sexual health in older age

Springer Medicine

Association Between Delayed/Forgone Medical Care and Resource Utilization Among Women with Breast Cancer in the United States

Abstract

Background

Methods

Results

Conclusions

Other articles of this Issue 4/2025

ASO Author Reflections: Real-World Results of the KEYNOTE-522 Regimen to Guide Surgical Decision Making

ASO Visual Abstract: Stage-Specific Tumoral Gene Expression Profiles of Black and White Patients with Colon Cancer

Predictors of Bilateral Disease in Low-Risk Papillary Thyroid Cancer: Histopathologic Insights and Preoperative Ultrasonography

miR-484 as an “OncomiR” in Breast Cancer Promotes Tumorigenesis by Suppressing Apoptosis Genes

ASO Author Reflections: High Rate of Positive Surgical Margins Following Pelvic Exenteration in the USA: A Call to Action

Survival After Orbital Exenteration for Primary Cutaneous Squamous Cell Carcinoma: A Retrospective Cohort Study

Mastering chronic pancreatitis pain: A multidisciplinary approach and practical solutions

Podcast | Sexual health in older age

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content