The numbers of breast cancer survivors are increasing yearly, as is the number of uninsured patients, who may experience greater burdens accessing care and poorer outcomes after a diagnosis of breast cancer. However, little is known about breast cancer care and survivorship issues facing underserved women, who are disproportionately poor and minority. The Breast and Cervical Cancer Treatment Program (BCCTP) is a federally legislated Medicaid (""""""""Medi-Cal"""""""" in California) program to address the needs of low-income, un- and under-insured women with breast cancer. In California there are two arms to the program - one federally funded, one state funded - the latter with more limited coverage. From an initial, statewide cohort of 1000 women enrolled in BCCTP, we will conduct prospective, longitudinal patient surveys at 3- and 5-years post breast cancer diagnosis, supplemented by 6- and 18-month treatment and patient survey data collected in our current study to assess: 1) Follow-up breast cancer care and age- and gender-appropriate cancer screening for the 3 years after diagnosis, and determinants of receipt of appropriate care at the individual- (e.g., comorbid medical conditions, competing life needs), interpersonal- (e.g., patient-physician communication, social support), and system-levels (e.g., state vs. federal BCCTP, provider characteristics, setting of care); 2) survivorship over the 5 years after diagnosis, including health, functioning, quality of life, and recurrence, as a function of these individual-, interpersonal-, and system-level factors. Because of their health policy implications, we will examine outcome differences between state and federal BCCTP enrollees. Additionally, we will be able to closely investigate these outcomes among Latinas, the second largest racial/ethnic group in the U.S., about which little is known, and who constitute 53% of our sample. As far we are aware, this is the first longitudinal study to examine determinants of quality of follow-up breast cancer care, as well as long-term survivorship, in a large Medicaid cohort of breast cancer patients. The project addresses three of NCI's four priority areas - health disparities, quality of care, and survivorship. The findings will lend a strong empirical basis to developing interventions and, given the project's partnership with Medi-Cal, the platform for instituting health policy changes at a state level, with possible national implications, to improve breast cancer care and survivorship for underserved women. ? ? ?
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