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Insurance Status Matters in Follicular Lymphoma, Study Finds

Mary Caffrey
Lower socioeconomic status is associated with poor survival in lymphoma.
Patients with follicular lymphoma (FL) lived longer if they had private insurance, according to a study that examined patient data in a national registry.

The study, published in the current issue of Blood, covers records of 43,648 patients from the National Cancer Database with FL who were diagnosed between 2004 and 2014. The study looked at 2 groups of patients: those younger than age 65, and those age 65 and older, to account for changes in insurance status with Medicare eligibility.

Among those studied, 47% had private insurance, 3% were uninsured, 4% had Medicaid, and 46% had Medicare.

People with FL may not experience symptoms right away, and sometimes the disease is discovered when a patient is being treated for another condition. Low socioeconomic status is associated with poor outcomes in FL, which the authors said suggests that access to care is a key factor in survival.

Survival rates can vary widely, from as little as 3 years to as long as 14 years. Therapies have changed dramatically, particularly with the rise of rituximab and the combination therapy, R-CHOP. Studies have previously shown a link between insurance coverage and survival rates.
                                                                                                       Read more about the economic burden of lymphoma.

Compared with patients under age 65 who had private insurance, those with no insurance, Medicaid, or Medicare had significantly worse overall survival (OS) after adjusting for socioeconomic factors:
  • Those with no insurance had a hazard ratio (HR) of 1.96; 95% CI, 1.69-2.28
  • Those with Medicaid had an HR of 1.82; 95% CI, 1.57-2.12
  • Those with Medicare had an HR of 1.96; 95% CI, 1.71, 2.24
When evaluating those age 65 and older the researchers only compared patients with Medicare only and patients who also had private insurance. Those with Medicare also had significantly worse OS (HR 1.28; 95% CI, 1.17-1.4).

The authors said the results show the importance of making sure patients have insurance coverage. “For adults with FL, expanding access to care through insurance has the potential to improve outcomes,” they wrote.


Goldstein JS, Nastoupil LJ, Han X, et al. Disparities in survival by insurance status in follicular lymphoma. Blood. 2018;132:1159-1166. doi:

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