Comparing Breast Cancer Treatment Outcomes Between Fee-for-Service and Medicare Advantage

OBJECTIVES: Medicare Advantage (MA) enrollment has increased over the past 2 decades. We compare receipt of standard treatment, time to treatment initiation (TTI), and overall survival (OS) between fee-for-service (FFS) Medicare and MA for women in Ohio with breast cancer. STUDY DESIGN: Retrospective cohort. METHODS: We used Ohio cancer registry data linked with Medicare enrollment files to identify women diagnosed between 2011 and 2016 with local- or regional-stage breast cancer. We evaluated the association between FFS or MA and each outcome, adjusting for age, race, marital status, county type, neighborhood poverty level, stage, hormone receptor status, and dual Medicare-Medicaid enrollment. Standard treatment was mastectomy or breast-conserving surgery plus radiotherapy; chemotherapy for regional disease; and hormone therapy if hormone receptor positive. RESULTS: A total of 12,349 patients met inclusion criteria (6801 FFS; 5548 MA). No difference was found in receipt of standard treatment between FFS and MA patients (adjusted OR [AOR], 0.99; 95% CI, 0.91-1.08) or between Black and White patients (AOR, 1.14; 95% CI, 0.94-1.40); however, Black patients with FFS had lower odds of standard treatment (AOR for interaction, 0.75; 95% CI, 0.57-0.99). We detected no difference in TTI (adjusted HR [AHR], 0.98; 95% CI, 0.94-1.01) or OS (AHR, 1.03; 95% CI, 0.92-1.15) between FFS and MA patients, and we found no significant interaction between MA status and race for OS or TTI. CONCLUSIONS: MA enrollment was not independently associated with standard treatment, TTI, or OS after cancer diagnosis. Further work is needed to understand why Black patients with FFS Medicare were less likely to receive standard treatment.