Association of Medicaid Insurance With Survival Among Patients With Small Cell Lung Cancer

Pezzi, Todd A.; Schwartz, David L.; Pisters, Katherine M.W.; Mohamed, A.S.R.; Welsh, James W.; Chang, Joe Y.; Liao, Zhongxing; Gandhi, Saumil; Byers, Lauren A.; Minsky, Bruce D.; Fuller, Clifton D.; Chun, Stephen G.

doi:10.1001/jamanetworkopen.2020.3277

Cited by 18 publications

(19 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Consistent with our findings, private and Medicare insurance were found to be associated with survival benefit in patients with SCLC, regardless of stage, although Medicaid was not associated with improved survival. 34 Similarly, MacLean et al 35 obtained data from 2006 to 2012 to compare the application of neoadjuvant and adjuvant chemotherapy in stage II and III NSCLC. Private insurance was shown to provide more survival advantage compared with public insurance.…”

Section: Discussionmentioning

confidence: 99%

Association of Race, Socioeconomic Factors, and Treatment Characteristics With Overall Survival in Patients With Limited-Stage Small Cell Lung Cancer

et al. 2021

View full text Add to dashboard Cite

IMPORTANCEIt has been established that disparities in race and socioeconomic status are associated with outcomes of non-small cell lung cancer. However, it remains unknown whether this extends to stage I, II, or III small cell lung cancer (SCLC), or limited-stage SCLC (L-SCLC). OBJECTIVE To investigate the associations of race, socioeconomic factors, and treatment characteristics with survival among patients with L-SCLC. DESIGN, SETTING, AND PARTICIPANTS Demographic information for patients with L-SCLC diagnosed between 2004 and 2014 was obtained from the National Cancer Database. The follow-up end point is death or last follow-up (date of last contact). Patients were divided into 5 mutually exclusive cohorts by race. Data analysis was performed in October 2019. MAIN OUTCOMES AND MEASURES Cox proportional hazards models were used to calculate univariable and multivariable models. Multivariable analyses were conducted to assess the associations of race and socioeconomic factors with risk-adjusted outcomes. Overall survival between groups was depicted by Kaplan-Meier curves. RESULTS Of 72 409 patients analyzed (median [range] age, 67.0 [23.0-90.0] years), 40 289 (55.6%) were women. The distribution of disease stage was 10 619 patients (14.7%) with stage I disease, 7689 patients (10.6%) with stage II disease, and 54 101 patients (74.7%) with stage III disease. The median (range) duration of follow-up was 8.2 (2.4-15.8) months. Compared with White patients, the hazard of death decreased to 0.92 (95% CI, 0.89-0.95; P < .001) for African American patients and 0.83 (95% CI, 0.77-0.91; P < .001) for Asian patients. The difference in median survival among different racial groups was significant only among those with stage III SCLC. Other factors associated with better survival were female sex, high income, high education, private insurance, diagnostic confirmation by positive cytological analysis, increase in number of sampled regional lymph nodes, and earlier stage at diagnosis. CONCLUSIONS AND RELEVANCE This analysis highlights disparities in race and socioeconomic factors associated with outcomes of L-SCLC. Racial minorities, including African American and Asian patients, have better survival than White patients for L-SCLC after adjustment for sociodemographic factors.

show abstract

Section: Discussionmentioning

confidence: 99%

Association of Race, Socioeconomic Factors, and Treatment Characteristics With Overall Survival in Patients With Limited-Stage Small Cell Lung Cancer

et al. 2021

View full text Add to dashboard Cite

show abstract

“…There have been contradictory data on the impact of insurance and survival in patients with SCLC. One study found that Medicaid was not associated with a survival benefit compared with being uninsured for patients with SCLC, 39 whereas another revealed worse survival for Medicaid patients. 17 , 40 In our cohort, private insurance was associated with the highest OS (9.2 mo), and patients with Medicaid had the second-highest survival (8.3 mo).…”

Section: Discussionmentioning

confidence: 99%

Racial and Other Healthcare Disparities in Patients With Extensive-Stage SCLC

Tapan

Furtado

Qureshi

et al. 2021

JTO Clinical and Research Reports

View full text Add to dashboard Cite

Introduction: Systemic treatment with chemotherapy is warranted for patients with extensive-stage SCLC (ES-SCLC). The objective of this study was to determine whether racial and other healthcare disparities exist in receipt of chemotherapy for ES-SCLC. Methods: Utilizing the National Cancer Database, 148,961 patients diagnosed to have stage IV SCLC from 2004 to 2016 were identified. Adjusted ORs with 95% confidence intervals (95% CIs) were computed for receipt of chemotherapy using multivariate logistic regression modeling. Cox regression modeling was used to perform overall survival analysis, and adjusted hazard ratios were calculated. Results: A total of 82,592 patients were included, among which chemotherapy was not administered to 6557 (7.9%). Higher education, recent year of diagnosis, and treatment at more than one facility were associated with increased odds of receiving chemotherapy. Factors associated with a decreased likelihood of receiving chemotherapy were increasing age, race, nonprivate insurance, and comorbidities. On multivariate analysis, black patients had lower odds of receiving chemotherapy compared with white patients (adjusted OR, 0.85; 95% CI: 0.77-0.93, p ¼ 0.0004). Furthermore, black patients had better survival compared with white patients (adjusted hazard ratio, 0.91; 95% CI: 0.89-0.94, p ¼ 0.91). The 1-year survival (median survival) for black and white patients was 31.7% (8.3 mo) and 28.6% (8 mo), respectively. Conclusions: Black patients with ES-SCLC were less likely to receive chemotherapy, as were elderly, uninsured, and those with nonprivate insurance. Further studies are required to address underlying reasons for lack of chemotherapy receipt in black patients with ES-SCLC and guide appropriate interventions to mitigate disparities.

show abstract

“…One study of patients with lung cancer found that Medicaid was not associated with improved overall survival compared with noninsurance, suggesting the need for further intervention at the policy level. 19 A recent study found that in patients with lung, colorectal, and breast cancer had improved survival with Medicaid expansion. 20 Cervical cancer is a highly screenable cancer in which Medicaid expansion may have a significant impact.…”

Section: Introductionmentioning

confidence: 99%

Association of Medicaid expansion and insurance status, cancer stage, treatment and mortality among patients with cervical cancer

et al. 2021

View full text Add to dashboard Cite

Background: Currently, little is known about the effect of the Patient Protection and Affordable Care Act's Medicaid expansion on care delivery and outcomes in cervical cancer.Aim: We evaluated whether Medicaid expansion was associated with changes in insurance status, stage at diagnosis, timely treatment, and survival outcomes in cervical cancer.Methods and results: Using the National Cancer Database, we performed a difference-in-differences (DID) cross-sectional analysis to compare insurance status, stage at diagnosis, timely treatment, and survival outcomes among cervical cancer patients residing in Medicaid expansion and nonexpansion states before (2011)(2012)(2013) and after (2014-2015) Medicaid expansion. January 1, 2014 was used as the timepoint for Medicaid expansion. The primary outcomes of interest were insurance status, stage at diagnosis, treatment within 30 and 90 days of diagnosis, and overall survival. Fifteen thousand two hundred sixty-five patients (median age 50) were included: 42% from Medicaid expansion and 58% from nonexpansion states. Medicaid expansion was significantly associated with increased Medicaid coverage (adjusted DID = 11.0%, 95%CI = 8.2, 13.8, p < .01) and decreased rates of uninsured (adjusted DID = −3.0%, 95%CI = −5.2, −0.8, p < .01) among patients in expansion states compared with non-expansion states. However, Medicaid expansion was not associated with any significant changes in cancer stage at diagnosis or timely treatment. There was no significant change in survival from the pre-to post-expansion period in either expansion or nonexpansion states, and no significant differences between the two (DID-HR = 0.95, 95%CI = 0.83, 1.09, p = .48). Conclusion:Although Medicaid expansion was associated with an increase in Medicaid coverage and decrease in uninsured among patients with cervical cancer, the effects of increased coverage on diagnosis and treatment outcomes may have yet to unfold. Future studies, including longer follow-up are necessary to understand the effects of Medicaid expansion.

show abstract

Association of Medicaid Insurance With Survival Among Patients With Small Cell Lung Cancer

Cited by 18 publications

References 26 publications

Association of Race, Socioeconomic Factors, and Treatment Characteristics With Overall Survival in Patients With Limited-Stage Small Cell Lung Cancer

Association of Race, Socioeconomic Factors, and Treatment Characteristics With Overall Survival in Patients With Limited-Stage Small Cell Lung Cancer

Racial and Other Healthcare Disparities in Patients With Extensive-Stage SCLC

Association of Medicaid expansion and insurance status, cancer stage, treatment and mortality among patients with cervical cancer

Contact Info

Product

Resources

About