Gynecologic cancer outcomes in the elderly poor: A population-based study

Area of Science:

• Gynecologic Oncology
• Health Services Research
• Geriatric Medicine

Background:

• Dual enrollment in Medicare and Medicaid identifies an at-risk population among older adults (≥65 years).
• Outcomes for women with gynecologic cancers within this dual-enrollment group were previously unknown.

Purpose of the Study:

• To investigate the association between dual Medicare and Medicaid enrollment and outcomes in older women diagnosed with gynecologic cancers.
• To analyze all-cause mortality and disease stage at diagnosis based on enrollment status.

Main Methods:

• Population-based cohort study utilizing North Carolina cancer registry data (2003-2009).
• Linked enrollment data for Medicare and Medicaid.
• Multivariate analysis and survival curves to compare outcomes between dually enrolled and non-dually enrolled women.

Main Results:

• Dual enrollees (18%) experienced a 34% increase in all-cause mortality compared to non-dually enrolled individuals.
• Increased mortality was observed across all gynecologic cancer sites, with notable disparities in vulvar/vaginal cancers (aHR, 1.93).
• Dual enrollees with uterine cancer had higher odds of advanced-stage diagnosis (aOR, 1.38), with the most significant survival disparities seen in early-stage uterine and vulvar/vaginal cancers.

Conclusions:

• Dual Medicare and Medicaid enrollment is associated with significantly increased all-cause mortality in older women with gynecologic cancers.
• Early-stage uterine and vulvar/vaginal cancers show the most pronounced outcome disparities, suggesting potential benefit from targeted interventions.
• These findings underscore the need for tailored healthcare strategies to mitigate disparities in this vulnerable patient population.