More Evidence That Health Insurance Status Affects Survival of Patients With Cancer

August 10, 2016
Ellie Leick

Patients with cancer who have Medicaid coverage or who are uninsured are more likely to be diagnosed later and receive improper treatment for cancer, according to two recent studies, and these factors can have an impact on their survival.

Patients with cancer who have Medicaid coverage or who are uninsured are more likely to be diagnosed later and receive improper treatment for cancer, according to two recent studies, and these factors can have an impact on their survival.

Researchers examined patients diagnosed between approximately 2007 and 2012 who were part of the Surveillance, Epidemiology, and End Results (SEER) database—one focusing on people with glioblastoma multiforme (GBM) and the other on those with testicular germ cell tumors.1,2 They looked at patient demographics such as race/ethnicity, income, education level, and geographic region, in addition to insurance and marital status, year of diagnosis, tumor size at time of diagnosis, and treatment modality.

GBM is the most common malignant primary brain tumor diagnosed in adults, but also one of the most difficult cancers to treat. It has a median survival rate of 14.6 months and a 5-year survival rate of less than 5%.

Among the 13,665 patients with GBM, 4.1% were uninsured, 11.1% had Medicaid, and 84.8% had non-Medicaid insurance.

About 76% of patients received surgical resection, and 78.5% of those patients received radiotherapy (RT) treatment before or after surgery. Compared with non-Medicaid insurance, Medicaid insurance was correlated with a lower likelihood of receiving surgical treatment. Similarly, both Medicaid-insured and uninsured people were less disposed to receiving adjuvant RT.

“This study indicates significant disparities in the management of glioblastoma patients under our existing healthcare insurance framework that need to be addressed,” noted Wuyang Yang, MD, MS, of Johns Hopkins University School of Medicine and co-lead author on the study.

In the other study, among the 10,211 men diagnosed with testicular tumors, 32% of uninsured men, 44% of men with Medicaid, and 24% of men with non-Medicaid insurance were diagnosed with the cancer in a metastatic state (stage II or III disease) at presentation. Men without insurance or with Medicaid were at an increased risk of being diagnosed with metastatic disease (26% and 60% increase, respectively), more likely to have intermediate or poor-risk disease, and more likely to present larger tumors than those with non-Medicaid insurance.

As for treatment, more than 95% of men overall received radical orchiectomy. However, uninsured men diagnosed with stage I seminoma were less likely to receive additional radiation after radical orchiectomy. Both uninsured men and men with Medicaid were less likely to undergo lymph node dissections, an important aspect of germ cell tumor care and an indicator of quality.

Overall, patients with Medicaid or without insurance had a shorter survival rate than their non-Medicaid insured peers. Uninsured men had a 58% increase risk of all-cause mortality and men with Medicaid had a 69% increase.

“Although testis cancer is curable with chemotherapy, this study supports the notion that lack of insurance may lead to delays in diagnosis and more advanced and less curable disease,” said the study’s lead author Christopher Sweeney, MBBS, of the Dana-Farber Cancer Institute. “Our findings support the belief that early diagnosis and management is key, and removal of barriers to access to health care should be implemented.”

Increased survival in non-Medicaid insured patients is attributed to many factors: non-Medicaid insurance is an indirect indicator of the socioeconomic status of patients who most likely have access to high-quality home and hospital care; uninsured patients often present with a later stage of the disease due to poor access to screening tests, leading to delayed diagnosis; and the financial burden for uninsured patients or those with Medicaid insurance might restrict timely access to newly developed therapeutic approaches.

“Moving forward, we need to place a greater focus on strategies and interventions addressing disparities,” wrote Michael Halpern, MD, PhD, Department of Health Services Administration and Policy, Temple University College of Public Health and Otis Brawley, MD, chief medical officer for the American Cancer Society, in an editorial accompanying the two studies.

“Researchers and clinicians need to work closely with policymakers and those delivering care in settings that focus on underserved populations to develop, implement, and evaluate approaches for improving access to quality cancer care.”

References

  • Rong X, Yang W, Garzon-Muvdi T et al. Influence of insurance status on survival of adults with glioblastoma multiforme: A population-based study [published online ahead of print Aug 8 2016] Cancer.
  • Markt SC, Lago-Hernandez CA, Miller RE et al. Insurance status and disparities in disease presentation, treatment, and outcomes for men with germ cell tumors [published online ahead of print Aug 8 2016] Cancer.