Preventative Cancer Screening Rates Among Uninsured Patients in Free Clinics: A Retrospective Cohort Study of Cancer Survivors and Non-cancer Survivors

Abstract

Background There is limited research on screening rates among uninsured cancer survivors. Uninsured cancer survivors are at higher risk of poorer health outcomes than the insured due to limited access to preventative screening for secondary cancers. This study examines the rates of surveillance and screening of uninsured cancer survivors and compares to uninsured patients without a cancer history seen in free clinics. Methods Data were collected retrospectively from electronic medical records and paper charts of patients from 10 free clinics between January 2016 and December 2018 in the Tampa Bay area. The prevalence of socioeconomic characteristics, cancer diagnoses, and screening practices were compared for cancer survivors and free clinic patients without a history of cancer. Study participants were determined to be eligible for cancer screenings based on the United States Preventive Services Task Force guidelines. Results Out of 13 982 uninsured patients frequenting free clinics between 2016 and 2018, 402 (2.9%) had a documented history of cancer. Out of the 285 eligible cancer survivors, 44 (15.4%) had completed age-appropriate colon cancer screening. Among the 170 female cancer survivors, 75 (44.1%) had completed breast cancer screenings, and only 5.9% (59/246) had completed cervical cancer screenings. After adjusting for age, gender, race, salary, employment status, and household size, cancer survivors were more likely to undergo colorectal cancer screening (OR: 3.59, 95% CI: 2.10–6.15) and breast cancer screening (OR: 2.13, 95% CI: 1.30–3.84) than patients without a cancer history. This difference was not seen for cervical cancer screening (OR: 0.99, 95% CI: .62–1.58). Conclusions Uninsured cancer survivors frequenting free clinics represent a unique population that is underrepresented in the medical literature. Our results suggest that uninsured survivors use screening services at higher rates when compared to uninsured patients without a reported cancer diagnosis. However, these rates are suboptimal when compared to national screening rates of insured cancer survivors.

Colorectal cancer screening utilization among breast, cervical, prostate, skin, and lung cancer survivors

“…In addition, limited time and workload pressure among providers may be the drivers for lack of communication between patient and provider [ 39 ]. Having insurance coverage to preventive health services for common cancer screening may also explain access to CRC screening [ 35 , 43 ], which is consistent with our finding that having insurance was associated with CRC screening uptake. Therefore, patient-physician CRC screening communication could become a critical channel for timely CRC screening use among cancer survivors [ 44 , 45 ].…”

“…Higher screening use from this study may be due to using registry-based data, which usually have more accurate information compared to self-reported data. Variations of CRC screening utilization across different cancer types may be influenced by doctor’s recommendations on screening tests [ 23 ] and CRC risk perceptions [ 33 , 34 ] as well as insurance coverage to access preventive care [ 32 , 35 ]. Finally, more research on examining CRC screening behaviors in skin and lung cancer survivors are needed due to lack of existing literature.…”

Temporal Trend in Uptake of the National General Health Checkups and Cancer Screening Program among Korean Women with Breast Cancer

“…Increases in screening rates among women with breast cancer were comparable to those in the general population during the same period from 2009 to 2016 [9]. Suboptimal cancer screening rates in cancer survivors and disparities in screening uptake in cancer survivors have been raised as problems in the management of secondary cancer prevention in survivorship care plans for cancer survivors [18][19][20][21]. Controversial results regarding cancer screening rates in cancer survivors compared with the general population or people without cancer have been reported.…”

County-level disparities in care for patients with glioblastoma

“…34,35 We found that adjuvant chemoradiotherapy was underutilized in communities with uninsured patients. This particular population faces severe barriers to accessing healthcare since they have low rates of preventive care screenings, 36 are less likely to see doctors for health concerns, 37 and have higher rates of emergency department use compared with insured patients. 38 Disruptions in insurance coverage reduce cancer treatment adherence and overall cancer survival.…”