Being uninsured puts patients at risk of delayed or suboptimal care for serious diseases, including colon cancer. While colon cancer is potentially curable at its early stages, those who lack insurance (or who have public insurance only) are less likely to receive screening, and some studies have demonstrated that those with no insurance or public insurance are less likely to receive the chemotherapy that can reduce the risk of recurrence in phase III disease.
Being uninsured puts patients at risk of delayed or suboptimal care for serious diseases, including colon cancer. While colon cancer is potentially curable at its early stages, those who lack insurance (or who have public insurance only) are less likely to receive screening, and some studies have demonstrated that those with no insurance or public insurance are less likely to receive the chemotherapy that can reduce the risk of recurrence in phase III disease.
Recently, the Surveillance, Epidemiology, and End Results (SEER) database began to include information on insurance status, providing researchers with an opportunity to study the effect of insurance status on cancer survival at the population level for the first time.
In the May issue of Diseases of the Colon & Rectum, investigators from the German Cancer Research Center in Heidelberg published results of a study that used the SEER database to assess the survival of 58,000 patients, aged 15 to 64 years, with colon cancer who were diagnosed between 2007 and 2012.
“We found that, as expected, survival was lower for patients who had no insurance,” said Dianne Pulte, MD, lead author of the paper. However, Pulte explained, patients who had Medicaid as their only insurance had survival rates similar to that observed in those who had no insurance at all.
Pulte and her team categorized patients by insurance type—13.7% had Medicaid and 7.5% were uninsured—and assessed the frequency of cases by cancer stage, sex, race, surgical resection, and the number of lymph nodes evaluated to determine whether insurance type influenced cancer stage at diagnosis, evaluation, and treatment. Complete analysis was used to determine 1-, 2-, and 3-year survival rates by insurance status.
Those who were uninsured or who had Medicaid only were more likely to present with stage IV disease than those who had other insurance; 34.5% of those with Medicaid and 32.8% of the uninsured presented with stage IV disease, compared with 24% of those with other insurance.
Among those who had stage I to stage III disease, 74.2% of those with Medicaid—versus 77.6% of those with other insurance—had 12 or more lymph nodes examined. Furthermore, 97.6% and 97.8% of patients with Medicaid and uninsured patients, respectively, had definitive surgery (versus 99.3% of those with other insurance).
Adjusted 3-year survival among the insurance groups was as follows:
The disparity in survival is likely multifactorial in nature, as those without insurance or with public insurance may be less likely to receive appropriate screening, which can result in later-stage disease at diagnosis. However, said Pulte, “Differences in rates of definitive surgery and adequate lymph node dissection explain some of this disparity,” a finding that is of particular interest because it is a potentially alterable risk factor.
More research into methods for decreasing these disparities and implementing public health measures to improve the quality of care for all patients is urgently needed, write the authors, to ensure the best survival outcomes on a population level.
Reference
Pulte D, Jansen L, Brenner H. Disparities in colon cancer survival by insurance type: a population-based analysis. Dis Colon Rectum. 2018;61(5):538-546. doi: 10.1097/DCR.0000000000001068.
Dr Kathy Zackowski Discusses the Importance of Rehabilitation Research and Trials in MS
April 26th 2024Kathy Zackowski, PhD, National MS Society, expresses the inherent value of quality rehabilitation trials for broadening clinical understandings of multiple sclerosis (MS) and bettering patient outcomes.
Read More
Examining Low-Value Cancer Care Trends Amidst the COVID-19 Pandemic
April 25th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the April 2024 issue of The American Journal of Managed Care® about their findings on the rates of low-value cancer care services throughout the COVID-19 pandemic.
Listen
Empowering Community Health Through Wellness and Faith
April 23rd 2024To help celebrate and recognize National Minority Health Month, we are bringing you a special month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. In the third episode, Camille Clarke-Smith, EdD, MS, CHES, CPT, discusses approaching community health holistically through spiritual and community engagement.
Listen
Kaiser Permanente was hit by a data breach in mid-April, impacting 13.4 million health plan members; GlaxoSmithKline (GSK) sued Pfizer and BioNTech for allegedly infringing on its messenger RNA technology patents in the companies’ COVID-19 vaccines; the CDC announced the first-known HIV cases transmitted via cosmetic injections.
Read More