A Comparative Analysis of Treatment Timelines and Insurance Types Among Patients with Breast Cancer Spine Metastases

Introduction: Breast cancer is projected to be the most diagnosed malignancy by 2040. While medical advancements have led to improvements in breast cancer prognoses, disparities in healthcare access, quality of care, and health outcomes persist among various population groups. Our study investigates evolving disparities in neurosurgical treatment for breast cancer spine metastases, particularly in relation to insurance type, aiming to assess differences in treatment time lengths between privately and non-privately insured patients.

Methods: This is a retrospective multi-institutional study of patients who underwent spine surgery for symptomatic breast cancer spine metastases from 2008 to 2021 at the Massachusetts General Hospital and Brigham and Women’s Hospital. We studied treatment time length at various surgical treatment phases stratified. Wilcoxon signed-rank tests and chi-square tests were used to analyze continuous and categorical variables, respectively, when stratifying the cohort by their insurance type.

Results: We analyzed data from 64 patients, all female-sex, who underwent surgical resection for breast cancer metastases to the spine. The results revealed significant differences between private and non-private insured groups. Patients with private insurance were, on average (mean, SD), younger (51, 11.8 years) at the time of surgery compared to those with non-private insurance (65, 12.6 years; p < 0.001). The hospital length of stay was shorter for privately insured patients with a mean length of stay 7 days (SD, 5.4) compared to 10 days (SD, 6.2) for non-privately insured patients (p=0.032). The duration from the primary cancer diagnosis to the development of spine metastases was significantly shorter in the private insurance groups (p = 0.045).

Conclusion : Our research underscores the importance of addressing disparities in the care of breast cancer patients with spine metastases related to each patient’s type of insurance coverage. These disparities have significant implications for treatment timelines and access to care. Therefore, any initiatives aimed at reducing these disparities must recognize the pivotal role insurance plays in ensuring timely and suitable treatment for these patients. By implementing interventions that take into account insurance-related barriers, we can pave the way for more equitable healthcare outcomes for individuals grappling with this complex disease.