Evaluation of Insurance Coverage and Cancer Stage at Diagnosis Among Low-Income Adults With Renal Cell Carcinoma After Passage of the Patient Protection and Affordable Care Act

Javier‐Desloges, Juan; Yuan, Julia; Soliman, Shady; Hakimi, Kevin; Meagher, Margaret; Ghali, Fady; Hsiang, Walter; Patel, Devin; Kim, Simon P.; Murphy, James D.; Parsons, J. Kellogg; Derweesh, Ithaar

doi:10.1001/jamanetworkopen.2021.16267

Cited by 6 publications

(2 citation statements)

References 19 publications

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“…Having health insurance can affect the stage at which ccRCC is diagnosed and therefore the treatments needed. 141 However, individuals with cancer are required to pay a larger proportion of their treatment costs through deductibles and coinsurance, and the costs of RCC treatment have been increasing over time. [142][143][144] Higher patient out-of-pocket costs have been shown to be a barrier to initiating and adhering to recommended cancer treatments.…”

Section: Cost Implicationsmentioning

confidence: 99%

Management of Metastatic Clear Cell Renal Cell Carcinoma: ASCO Guideline

Rathmell

Rumble

Veldhuizen

et al. 2022

JCO

166

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PURPOSE To provide recommendations for the management of patients with metastatic clear cell renal cell carcinoma (ccRCC). METHODS An Expert Panel conducted a systematic literature review to obtain evidence to guide treatment recommendations. RESULTS The panel considered peer-reviewed reports published in English. RECOMMENDATIONS The diagnosis of metastatic ccRCC should be made using tissue biopsy of the primary tumor or a metastatic site with the inclusion of markers and/or stains to support the diagnosis. The International Metastatic RCC Database Consortium risk criteria should be used to inform treatment. Cytoreductive nephrectomy may be offered to select patients with kidney-in-place and favorable- or intermediate-risk disease. For those who have already had a nephrectomy, an initial period of active surveillance may be offered if they are asymptomatic with a low burden of disease. Patients with favorable-risk disease who need systemic therapy may be offered an immune checkpoint inhibitor (ICI) in combination with a vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitor (TKI); patients with intermediate or poor risk should be offered a doublet regimen (no recommendation was provided between ICIs or an ICI in combination with a VEGFR TKI). For select patients, monotherapy with either an ICI or a VEGFR TKI may be offered on the basis of comorbidities. Interleukin-2 remains an option, although selection criteria could not be identified. Recommendations are also provided for second- and subsequent-line therapy as well as the treatment of bone metastases, brain metastases, or the presence of sarcomatoid features. Participation in clinical trials is highly encouraged for patients with metastatic ccRCC. Additional information is available at www.asco.org/genitourinary-cancer-guidelines

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Section: Cost Implicationsmentioning

confidence: 99%

Management of Metastatic Clear Cell Renal Cell Carcinoma: ASCO Guideline

Rathmell

Rumble

Veldhuizen

et al. 2022

JCO

166

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“…In the context of RCC, previous studies have shown that possessing health insurance leads to earlier detection, 20 and access to private health insurance is associated with prolonged cancer-specific survival compared to Medicaid insurance. 21 Similarly, we observed higher rates of Medicaid insurance/uninsured among Latinx patients compared to non-Latinx patients (83% vs. 20%, P < .0001).…”

Section: Discussionmentioning

confidence: 99%

Real-World Outcomes of Latinx Versus Non-Latinx Patients Treated With First-Line Immunotherapy for Metastatic Renal-Cell Carcinoma

et al. 2023

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Background There are limited data regarding the impact of ethnicity among patients receiving immune checkpoint inhibitors. We evaluated real-world outcomes between Latinx and non-Latinx patients with metastatic renal-cell carcinoma (mRCC) treated with first-line nivolumab/ipilimumab within 2 different healthcare settings. Methods We performed a retrospective analysis of patients with mRCC who received nivolumab/ipilimumab within the Los Angeles County Department of Health Services (LAC-DHS), a safety-net healthcare system, and the City of Hope Comprehensive Cancer Center (COH), a tertiary oncology center, between January 1, 2015 and December 31, 2021. Progression-free survival (PFS) and overall survival (OS) were determined using the Kaplan-Meier method and covariates were adjusted using multivariate Cox proportional hazards regression. Results Of 94 patients, 40 patients (43%) were Latinx while the remainder were non-Latinx (44 pts [46%] White, 7 pts [7%] Asian, and 3 pts [3%] Other). Fifty (53%) and 44 (47%) patients received their care at COH and LAC-DHS, respectively. Most Latinx patients (95%) were treated at LAC-DHS, and most non-Latinx patients (89%) were treated at COH. Pooled analysis by ethnicity demonstrated significantly shorter PFS in Latinx versus non-Latinx patients (10.1 vs. 25.2 months, hazard ratios [HR] 3.61, 95% CI 1.96-6.66, P ≤ .01). Multivariate analysis revealed a HR of 3.41 (95% CI 1.31-8.84; P = .01). At a median follow-up of 11.0 months, the median OS was not reached in either arm at the time of data cutoff. Conclusion Latinx patients with mRCC had a shorter PFS treated with frontline nivolumab/ipilimumab compared to their non-Latinx counterparts. No difference was observed in OS although these data were immature. Larger studies are needed to further interrogate the social and economic determinants of ethnicity on clinical outcomes in mRCC.

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