Breast Cancer Survival, Work, and Earnings

Relying on data from the Health and Retirement Study, we examine differences between breast cancer survivors and a non-cancer control group in employment, hours worked, wages, and earnings. Overall, breast cancer has a negative impact on the decision to work. However, among survivors who work, hours of work and, correspondingly, annual earnings are higher compared to women in the non-cancer control group. These findings suggest that while breast cancer has a negative effect on women's employment, breast cancer may not be debilitating for those who remain in the work force. We explore numerous possible biases underlying our estimates especially selection based on information in the Health and Retirement Study, and examine related evidence from supplemental data sources.

The Effects of Health Shocks on Employment and Health Insurance: The Role of Employer-Provided Health Insurance

We study how men’s dependence on their own employer for health insurance affects labor supply responses and loss of health insurance coverage when faced with a serious health shock. Men with employment-contingent health insurance (ECHI) are more likely to remain working following some kinds of adverse health shocks, and are more likely to lose insurance. With the passage of health care reform, the tendency of men with ECHI as opposed to other sources of insurance to remain employed following a health shock may be diminished, along with the likelihood of losing health insurance.

Employment-Contingent Health Insurance, Illness, and Labor Supply of Women: Evidence from Married Women with Breast Cancer

We examine the effects of employment-contingent health insurance on married women's labor supply following a health shock. First, we develop a theoretical model that examines the effects of employment-contingent health insurance on the labor supply response to a health shock, to clarify under what conditions employment-contingent health insurance is likely to dampen the labor supply response. Second, we empirically evaluate this relationship using primary data. The results from our analysis find that -- as the model suggests is likely -- health shocks decrease labor supply to a greater extent among women insured by their spouse's policy than among women with health insurance through their own employer. Employment-contingent health insurance appears to create incentives to remain working and to work at a greater intensity when faced with a serious illness.

Job attributes, job satisfaction and the return to health after breast cancer diagnosis and treatment

Background: As detection and treatment of cancer has advanced, the number of working age women with breast cancer has increased. This study provides new information on the intersection of breast cancer treatment and job tasks and how, together, they impact employed and newly diagnosed women. Methods: The sample comprised 493 employed women within two months of initiating treatment. Job satisfaction and demands were assessed by pre-diagnosis recall along with measures of mental and physical health and assessed again nine months after initiating treatment. Using seemingly unrelated regression, we tested the effect of job tasks and satisfaction on mental and physical health nine months post-treatment initiation, controlling for pre-diagnosis health status, patient characteristics, and job tasks. Results: Physical job demands prior to diagnosis were not significantly associated with mental or physical health nine months after treatment initiation. Employment in cognitively demanding and less satisfying jobs was associated with decreases in mental health and increases in problems with work or daily activities nine months post-treatment initiation (p\u3c0.05). Women who received five or more cycles of chemotherapy reported lower vitality, social functioning, and worse measures of physical health compared to those who did not receive chemotherapy (p\u3c0.05). Conclusions: Employment in cognitively demanding and unsatisfying jobs may impede mental health recovery, particularly in patients who receive longer chemotherapy regimens. Such information may be used by patients and clinicians in deciding when to undergo chemotherapy and whether job tasks can be restructured to hasten recovery

Differences in Breast Cancer Diagnosis and Treatment:Experiences of Insured and Uninsured Patients in a Safety Net Setting

To explore how well the safety net performs at eliminating differences in diagnosis and treatment of insured and uninsured women with breast cancer, we compared insured and uninsured women treated in a safety net setting. Controlling for socioeconomic characteristics, uninsured women are more likely to be diagnosed with advanced disease, requiring more extensive treatment relative to insured women, and also experience delays in initiating and completing treatment. The findings suggest that, despite the safety net system, uninsured women with breast cancer are likely to require more costly treatment and to have worse outcomes, relative to insured women with breast cancer.

Longitudinal analysis of censored medical cost data

This paper applies the inverse probability weighted (IPW) least-squares method to estimate the effects of treatment on total medical cost, subject to censoring, in a panel-data setting. IPW pooled ordinary-least squares (POLS) and IPW random effects (RE) models are used. Because total medical cost might not be independent of survival time under administrative censoring, unweighted POLS and RE cannot be used with censored data, to assess the effects of certain explanatory variables. Even under the violation of this independency, IPW estimation gives consistent asymptotic normal coefficients with easily computable standard errors. A traditional and robust form of the Hausman test can be used to compare weighted and unweighted least squares estimators. The methods are applied to a sample of 201 Medicare beneficiaries diagnosed with lung cancer between 1994 and 1997

Polypectomy Techniques, Endoscopist Characteristics, and Serious Gastrointestinal Adverse Events

Background: A use of polypectomy techniques by endoscopist specialty (primary care, surgery, and gastroenterology) and experience (volume), and associations with serious gastrointestinal adverse events, were examined. Methods: A retrospective follow-up study with ambulatory surgery and hospital discharge datasets from Florida, 1999-2001, was used. Thirty-day hospitalizations due to colonic perforations and gastrointestinal bleeding were investigated for 323,585 patients. Results: Primary care endoscopists and surgeons used hot biopsy forceps/ablation, while gastroenterologists provided snare polypectomy or complex colonoscopy. Low-volume endoscopists were more likely to use simpler rather than complex procedures. For hot forceps/ablation and snare polypectomy, low- and medium-volume endoscopists reported higher odds of adverse events. For complex colonoscopy, higher odds of adverse events were reported for primary care endoscopists (1.74 [95%CI, 1.18 to 2.56]) relative to gastroenterologists Conclusions: Endoscopists regardless of specialty and experience can safely use cold biopsy forceps. For hot biopsy and snare polypectomy, low volume, but not specialty, contributed to increased odds of adverse events. For complex colonoscopy, primary care specialty, but not low volume, added to the odds of adverse events. Comparable outcomes were reported for surgeons and gastroenterologists. Cross-training and continuing medical education of primary care endoscopists in high-volume endoscopy settings are recommended for complex colonoscopy procedures

The MUC1 Cytoplasmic Tail and Tandem Repeat Domains Contribute to Mammary Oncogenesis in FVB Mice

Background: Though the importance of the transmembrane mucin MUC1 in mammary oncogenesis has long been recognized, the relative contributions of the cytoplasmic tail and tandem repeat domains are poorly understood.Methods: To address this, mouse models of mammary carcinogenesis were created expressing full-length, cytoplasmic tail-deleted, or tandem repeat-deleted MUC1 constructs.Results: Overexpression of full-length MUC1 resulted in tumor formation in young mice (12 months); however, loss of either the cytoplasmic tail or the tandem repeat domain abrogated this oncogenic capacity. Aged mice in all strains developed late-onset mammary tumors similar to those previously described for the FVB background.Conclusions: This study is the fi rst spontaneous cancer model to address the relative importance of the cytoplasmic tail and tandem repeat domains to MUC1-driven mammary oncogenesis, and suggests that both of these domains are essential for tumor formation

Estimation from Censored Medical Cost Data

This paper applies the inverse probability weighted least-squares method to predict total medical cost in the presence of censored data. Since survival time and medical costs may be subject to right censoring and therefore are not always observable, the ordinary least-squares approach cannot be used to assess the effects of explanatory variables. We demonstrate how inverse probability weighted least-squares estimation provides consistent asymptotic normal coefficients with easily computable standard errors. In addition, to assess the effect of censoring on coefficients, we develop a test comparing ordinary leastsquares and inverse probability weighted least-squares estimators. We demonstrate the methods developed by applying them to the estimation of cancer costs using Medicare claims data