An innovative approach to the multidisciplinary treatment of uninsured breast cancer patients

Purpose A significant proportion of many populations remain uninsured. The aim of the study was to assess differences in breast cancer outcomes before and after the implementation of an innovative approach to the multidisciplinary treatment of uninsured breast cancer patients. Methods Retrospective review was performed of patients seen at a safety net hospital from January 2000 to December 2020. Beginning July 2006 an innovative approach was implemented to lower patient costs to facilitate care of uninsured patients. Results The study included 1,797 patients, 661 patients before the changes (BCS), 1,136 patients after implementation of the new cost saving approach (ACS). The mean age was 53 years. The majority were uninsured (56%) or insured by Medicaid (31%). Only 18% underwent screening mammography. The ACS group had a higher rate of breast conservation (75% vs 47%, p < 0.001). A higher percentage of the ACS group received adjuvant therapy: Chemotherapy (91% vs 70%, p < 0.001), Radiation therapy (91% vs 70%, p < 0.001), and initiated endocrine therapy (87% vs 67%, p < 0.001). After follow up of 8 years, these changes resulted in lower ipsilateral breast tumor recurrence (2% vs 16%, p < 0.001) and chest wall recurrence (5% versus 8%) and improvement in overall survival (90% vs 81%, p < 0.001). Conclusion Peer reviewed literature is replete of studies documenting disparities in breast cancer treatment. The current study describes a successful cost limiting method which takes advantage of existing financial assistance programs to improve care in uninsured patients.