Comorbidities, risk, and socioeconomic factors of uninsured cancer survivors

Abstract

Cancer patients can be well-connected to resources during treatment but become lost to follow-up and subsequently may receive treatment in free clinics for chronic morbidities. Few studies have examined outcomes for uninsured patients with cancer histories in free clinics, but research examining socioeconomic determinants emphasizes poor cancer outcomes for patients with lower socioeconomic statuses (SES). Demographic data and chronic disease measures were extracted from medical charts of patients treated in 8 free clinics in 2016 in Tampa Bay. Descriptive statistics and Pearson correlation coefficients were used to demonstrate relationships between socioeconomic factors, cancer diagnoses, and comorbidities. Charlson Comorbidity Index (CCI) was used to assess mortality risk and severity of disease burden. The histories of 4804 uninsured patients were evaluated, identifying 86 (1.7%) as having had cancer. They were predominantly female (65.1%) and significantly older than those without cancer histories. Average duration from initial diagnosis was approximately 8.53 years (standard deviation [SD] 7.55). Overall, cancer patients had higher CCI scores (3.04 [1.928 SD] versus 0.90 [1.209 SD]; P <.001); thus reflecting more weighted comorbidities than patients without cancer ( P <.001). Other factors of chronic disease including obesity and substance abuse correlated with cancer history. Among uninsured patients, those with cancer histories had greater mortality risk by CCI than those without. Chronic conditions such as diabetes, cerebrovascular disease, and chronic pulmonary disease existed in patients with cancer histories, affecting their mortality risk. Uninsured patients with a history of cancer are in greater need for chronic disease management and prevention.

Substance Use in Uninsured Cancer Survivors: A Multicenter Cross-Sectional Study of Free Clinics

“…There were 222 (3.2%) patients with a history of cancer in our study sample. The most common cancers reported were breast (n = 50, 22.5%), prostate (n = 20, 9.0%), colon (n = 12, 5.4%), melanoma (n = 10, 4.5%), and lung (n = 9, 4.1%); this distribution was similar to previously reported findings using one year of data from this population [12]. Cancer survivors had a median age of 55 (interquartile range 48-61).…”

“…Past use was defined as prior use with documentation of cessation. [12] Measures of association between cancer history and substance use are presented as crude odds ratios (OR) and adjusted odds ratios (aOR) after controlling for age (entered as a quadratic term after assessing linearity), sex, and race/ethnicity. Measures of association were generated using separate multiple logistic regression models for smoking, alcohol, and drug use.…”

Secondary prevention among uninsured stroke patients: A free clinic study

“…It is also possible that minorities and the uninsured may have a higher chronic disease burden and had lengthy medical histories that may have not been completely elicited or difficult to clinically evaluate in short appointments. 18 , 19 …”

Impact of Cost-Related Medication Nonadherence on Economic Burdens, Productivity Loss, and Functional Abilities: Management of Cancer Survivors in Medicare

“…Cancer survivors are often treated with extensive and expensive treatments such as chemotherapy, immunotherapy, and nonpharmacological treatments ( Baskar et al, 2012 ). Since cancer survivors are more likely to have chronic comorbidities, they have to be treated for those chronic illnesses as well ( Mirza et al, 2018 ). Due to the high costs of the medications in the treatment and the treatment itself, cancer survivors are more than twice as likely to not adhere to medication treatments ( Zhang and Meltzer, 2015 ; Smith et al, 2019 ; Zhao et al, 2019 ).…”