Many American Indians and Alaska Natives (AI/ANs) with cancer are insured through the Medicaidprogram. In our previous Project EXPORT study of AI/AN Medicaid enrollees with cancer (5 P60 MD00508),we detected an extraordinary number of newly diagnosed cancer patients who disenrolled from the Medicaidprogram within months of diagnosis. In this study, we propose to survey AI/ANs diagnosed with cancer todetermine their insurance status, enrollment and disenrollment history, and whether disenrollment influencedtheir access to cancer care services. To create this resource, we will update our ongoing link of patientrecords from the Indian Health Service, the Washington State Cancer Registry, and Medicaid.
Our Specific Aims are to:1) Update our comprehensive sociodemographic, clinical, and claims database for AI/AN cancerpatients through linking -- at the patient level records from the Washington State CancerRegistry, clinic enrollment data from Indian Health Service and tribal clinics, and Medicaidenrollment and claims records. This database will encompass all AI/AN patients with adocumented diagnosis of cancer from 1997 to 2004, with follow-up claims through 2006.2) Conduct in-person interviews with tribal health workers, AI/AN cancer patients and caregivers,with the goal of identifying:a. Reasons why AI/ANs disenroll from Medicaid after they are diagnosed with cancer; andb. Whether disenrollment results in delays in use or nonuse of recommended cancer therapiesand follow-up procedures.To better understand the impact of disenrollment on care and follow-up, we will interview AI/ANs who didand did not disenroll from Medicaid following their cancer diagnosis.3) For AI/AN patients with cancer who are enrolled in the Medicaid program, determine whetherdisenrollment within 2 years of diagnosis is associated with poorer cancer-specific survival.Our study is greatly enhanced by the close working partnerships among the Fred Hutchinson CancerResearch Center, the University of Washington's Native People for Cancer Control, the Washington StateMedicaid program, and the Northwest Portland Area Indian Health Board.
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