Abstract C07: Transitions to Medicare for Cancer Care Services: A Study of Safety Net Clinics in Georgia

Background: Advanced age and low socioeconomic status are major risk factors for cancer among women in the United States. Beginning at age 50, the probability of developing invasive cancer increases for women for almost every major type of cancer, including breast, colon, lung, and uterine cancer. Furthermore, uninsured patients and those from many ethnic minority groups are substantially more likely to be diagnosed with cancer at a later stage. Safety net health care providers offer primary care as well as cancer screening services for medically underserved patients. Publicly funded programs, such as the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), offer breast and cervical cancer screening services in many of these safety net settings. Little is known, however, about whether and to what extent safety net providers prepare older women for transitions to cancer care once they become eligible for Medicare and age out of publicly funded cancer screening programs like the NBCCEDP. To better inform future research, policy, and intervention programs designed to promote a coordinated transition to cancer screening and treatment among older women using safety net services, this study explored safety net provider practices about transitions to cancer care in Georgia. Study Purpose: The purpose of this study was to: 1) assess the extent to which safety net clinics in Georgia provide cancer screening services to medically underserved women ages 50 and older; and (2) explore safety net provider policies and practices for assisting older women to transition to Medicare for their cancer care services. Methods: This study applied an explanatory sequential mixed methods design. The quantitative phase included an online-survey with safety net providers who offer breast and cervical cancer screening services to older, uninsured and medically vulnerable women in Georgia. The survey addressed clinic and client characteristics, provision of cancer care services, health education and patient navigation services, and policies and practices specific to care transitions. In-depth interviews with a purposive sample of participating providers were conducted as the following explanatory qualitative phase to explore the survey results in greater detail. Results and Implications: Quantitative survey results from 193 safety net clinic providers in Georgia indicate about 20% of their clientele are uninsured women ages 50-64. A large majority of clinics offer breast and cervical cancer screening services (95%), as well as referrals for diagnostic follow-up (80%) and referrals for cancer treatment via the Georgia Women9s Health Medicaid Program (82%). Most safety net clinics (57%) do not provide cancer screening services to women older than age 65 and do not have a formal policy in place to help these older women transition to Medicare for their cancer care (51%). However, about one-third of safety net clinics offer some information or informal counseling to older women about how to enroll in Medicare and find a Medicare-participating provider. Qualitative findings suggest that providers support the development of a care coordination model, such as patient navigation, to assist older women in their transition from safety net clinics to private, Medicare providers for cancer care services. Enhanced provider education and training regarding Medicare benefits and policies was also recommended. Considered together, these strategies offer an opportunity to enhance safety net provision of cancer screening services for older women and to create new models of transition cancer care for the medically underserved in Georgia Citation Format: Sarah Blake, Jonathan Hawley, Susanne Erni, Arpita Mehrotra. Transitions to Medicare for Cancer Care Services: A Study of Safety Net Clinics in Georgia. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C07.