Factors affecting receipt of invasive pain management among Medicaid beneficiaries with cancer.

7 Background: Previous studies have reported that a substantial proportion of cancer patients do not receive appropriate pain management. Inadequate pain management may be greater among Medicaid beneficiaries with cancer. However, it is unknown whether Medicaid policies or patient characteristics affect the likelihood of receiving pain management services.

METHODS: We used 2006-2008 Medicaid claims data for individuals diagnosed with breast or colon cancer to assess patient characteristics and state-level policy factors associated with receipt of invasive pain management (IPM). Generalized estimating equations (GEE) were used to examine factors influencing receipt of IPM, including patient age, race/ethnicity, comorbidities, Medicaid reimbursements, redetermination period for Medicaid eligibility, required patient co-payments. Separate analyses were performed for the breast and colon cancer study populations.

RESULTS: Overall, 3% of Medicaid beneficiaries in the study population with breast cancer and 6% with colon cancer received IPM. Among the breast cancer population, non-white patients were significantly less likely to receive IPM compared with white breast cancer patients (Odds Ratio (OR) = 0.88, p < 0.0001). Increased comorbidity score was associated with significantly increased likelihood of IPM (OR = 1.27, p < 0.0001). Among the colon cancer population, older age was associated with significantly increased likelihood of IPM (OR = 1.36 for 10 years of age, p = 0.02). Patients in states with a Medicaid eligibility re-determination period of 12 months were less likely to receive IPM compared to those in states with a period < 12 months (OR = 0.60, p = 0.046).

CONCLUSIONS: Patient characteristics and (for colon cancer patients) state Medicaid policies predict receipt of IPM among Medicaid beneficiaries with cancer. As many of these factors are not associated with the need for pain management, quality improvements in supportive care are needed for this underserved population.