Insurance Status Associated With Varying Survival Outcomes in Lymphoma

According to a presentation at the ASH 2017 Annual Meeting & Exposition, insurance status heavily influenced treatment and survival outcomes among patients with Burkitt lymphoma (BL), but not patients with plasmablastic lymphoma (PBL).

BL is an aggressive but curable form of non-Hodgkin lymphoma, with 3-year survival rates exceeding 80% among patients treated in clinical trials. However, recent studies have suggested that real-world data may differ from patients treated in trials, due to insurance status.

Jean L Koff, MD, Emory University School of Medicine, and colleagues sought to determine the influence of insurance status on treatment and outcome patterns among adult patients with BL, and to compare them with those of patients with PBL, an aggressive lymphoma subtype associated with poor prognosis despite treatment.

Researchers accessed the National Cancer Database and identified 7073 patients with BL and 475 patients with PBL diagnosed between 2004 and 2014. The analysis included data from patients whose insurance status was present in their records. Patients with missing insurance data, or who had government insurance other than Medicare or Medicaid, were excluded.

The study was stratified by age (< 65 years vs ≥ 65 years). Among patients younger than 65 years (n = 5235), 65% had private insurance, 17.2% had Medicaid, 7.6% had Medicare, and 10.2% had no insurance. Among patients aged 65 years or older (n = 1838), 12.9% had private insurance, 1.5% had Medicaid, 85% had Medicare, and 0.65% had no insurance.

Factors associated with Medicaid or lack of insurance included black or Hispanic race, lower socioeconomic status, HIV-positive status, higher comorbidity scores, and presence of BL symptoms.

Using patients with private insurance as a reference, BL patients with public insurance or no insurance in both age groups experienced worse survival outcomes (< 65: no insurance, adjusted hazard ratio [HR], 1.41; Medicaid, adjusted HR, 1.17; Medicare, adjusted HR, 1.5; ≥ 65 years: no insurance, adjusted HR, 6; Medicare, adjusted HR, 1.33).

However, researchers did not observe a significant difference in survival outcomes for PBL patients after adjusting for insurance status.

Factors independently associated with worsened outcomes in younger patients included advanced stage disease, lack of treatment, lower socioeconomic status, HIV-positive status, higher comorbidity, and BL symptoms. For older patients, lower socioeconomic status, BL symptoms, and lack of treatment remained significant.

“Our findings suggest that expanding access to care may improve survival disparities for BL, for which curative therapies exist, but not for PBL, where more effective therapies are needed to improve outcomes,” researchers concluded.

—Cameron Kelsall