Heterogeneity in quality of care and cancer patient survival based on insurance coverage are the highlight of a report by researchers at the Institute for Population Health Improvement at the University of California Davis.
In an attempt to understand the existence of disparities in cancer care among Californians diagnosed with, and being treated for, cancer, researchers at the Institute for Population Health Improvement at the University of California Davis evaluated the stage at diagnosis, quality of treatment, and survival among those diagnosed with breast, colon, rectal, lung, and prostate cancer between 2004 and 2012. The outcome of the study? Significant disparities in survival and quality of care, dictated by the kind of insurance plan the individuals were enrolled in.
Using the California Cancer Registry (CCR), California’s population-based cancer surveillance system, the study evaluated 742,734 cases of the above listed cancers. The authors could successfully gather health insurance information for 703,603 cases, and based on the source of insurance, 7 categories were created: Medicare, Medi-Cal, Medicare-Medi-Cal dual eligible, private insurance, Department of Veteran’s Affairs (VA), Department of Defense (DOD), and uninsured.
The study found significant disparities based on the source of health insurance and gaps in quality of care, with Medi-Cal, Medicare-Medi-Cal dual eligibility, and the uninsured facing the highest number and largest disparities. Medi-Cal patients with breast, colon, and rectal cancer were more likely to be diagnosed at an advanced stage and have poor 5-year survival compared with those with alternate sources of insurance. Further, Medicare-Medi-Cal dual eligible were least likely to receive the specified treatment for breast and colon cancer.
A lag between diagnosis and treatment initiation was most common for VA patients with breast, colon, rectal, lung, and prostate cancers; however, they did fare better than patients with other types of insurance. Also, they were more likely to receive the recommended treatment compared with those covered by other health insurance.
“What’s particularly poignant is that we’re seeing these big disparate outcomes among groups in cancers where we have strong playbooks. There’s a body count and we’d like to figure out a better way to insure that all Californians are getting the recommended screening for these deadly cancers and treatment according to guidelines. We have a lot of work to do,” said Christina Clarke, a research scientist at the Cancer Prevention Institute of California and a consulting associate professor at the Stanford University School of Medicine, in reaction to the findings of this study.