Disparities in Stage at Diagnosis, Treatment, and Survival in Nonelderly Adult Patients With Cancer According to Insurance Status

Abstract

Purpose The purpose of this study was to determine the association of insurance status with disease stage at presentation, treatment, and survival among the top 10 most deadly cancers using the SEER database. Patients and Methods A total of 473,722 patients age 18 to 64 years who were diagnosed with one of the 10 most deadly cancers in the SEER database from 2007 to 2010 were analyzed. A Cox proportional hazards model was used for multivariable analyses to assess the effect of patient and tumor characteristics on cause-specific death. Results Overall, patients with non-Medicaid insurance were less likely to present with distant disease (16.9%) than those with Medicaid coverage (29.1%) or without insurance coverage (34.7%; P < .001). Patients with non-Medicaid insurance were more likely to receive cancer-directed surgery and/or radiation therapy (79.6%) compared with those with Medicaid coverage (67.9%) or without insurance coverage (62.1%; P < .001). In a Cox regression that adjusted for age, race, sex, marital status, residence, percent of county below federal poverty level, site, stage, and receipt of cancer-directed surgery and/or radiation therapy, patients were more likely to die as a result of their disease if they had Medicaid coverage (hazard ratio [HR], 1.44; 95% CI, 1.41 to 1.47; P < .001) or no insurance (HR, 1.47; 95% CI, 1.42 to 1.51; P < .001) compared with non-Medicaid insurance. Conclusion Among patients with the 10 most deadly cancers, those with Medicaid coverage or without insurance were more likely to present with advanced disease, were less likely to receive cancer-directed surgery and/or radiation therapy, and experienced worse survival.

Geographic disparities amongst patients with gynecologic malignancies at an urban NCI-designated cancer center

“…The state is composed of urban, rural and suburban populations with percentages similar to that of the United States as a whole; and contains large minority and immigrant populations in the city of Baltimore and the suburbs of Washington, DC. In the United States, the uninsured and those with Medicaid insurance coverage are more likely to present with advanced disease, less likely to receive cancerdirected surgery and/or radiation therapy, and have poorer overall survival than patients with commercial insurance [21]. Travel introduces an additional burden to care affecting both employment and family income, especially if a caregiver accompanies a patient to appointments.…”

Clinical Benefits Associated With Medicaid Coverage Before Diagnosis of Gynecologic Cancers

“…Prior research has found that Medicaid coverage at the time of cancer diagnosis confers survival benefits. 5 The implication of this work is that access to care before diagnosis is the driver of these benefits. The current results support this assumption by demonstrating that enrollment in Medicaid before diagnosis is associated with early-stage cancer diagnosis.…”

“…2 The expansion of Medicaid has been shown to increase use of preventive services, improve access to primary care, and decrease mortality among new enrollees. 3,4 Research has found that having health insurance after a cancer diagnosis improves outcomes, 5 but currently unknown is whether prediagnosis coverage yields additional benefits. Gynecologic cancers encompass screen-detectable (cervical), early-detectable (uterine, vulvar/vaginal), and poorly detectable (ovarian) disease.…”

Rising Rates of Upfront Surgery in Early Locally Advanced Cervical Cancer: What Factors Predict for This Treatment Paradigm?

“…Patients who are uninsured or who have government-based insurance including Medicare or Medicaid often present with socioeconomic challenges that inevitably guide their treatment; for example, patients who lack insurance present with more advanced disease, which can contribute to more morbid operations. 9,10 Other factors include transportation issues, willingness for providers to accept them in their practice due to lack of financial incentives, social and financial barriers, and lack of domestic support, which is critical in the postoperative recovery setting. 9,11 Year of diagnosis Perhaps most surprising were the rising rates of upfront hysterectomy followed by RT compared with CRT alone, increasing from 12% to 31% over the past decade.…”