Two studies published online in the journal Cancer have shown that patients’ health insurance status may impact outcomes following cancer diagnosis.
Using population-based data from the Surveillance, Epidemiology, and End Results program of the National Cancer Institutes, the studies looked at two cancer types and assessed how outcomes changed based on what type of insurance patients had.
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In a study of testicular cancer, researchers led by Christopher Sweeney, MBBS, Dana-Farber Cancer Institute (Boston, MA), looked at 10,211 men diagnosed with testicular cancer between 2007 and 2011. They found that patients who were uninsured or those that were covered under Medicaid had an increased risk of having larger testicular cancer or metastatic disease at initial diagnosis. These patients also tended to have cancer that was categorized as “intermediate” or “poor” risk and were more likely to die of their disease than those who were insured. Further, uninsured and Medicaid-covered patients were less likely to have their lymph nodes removed and; among those with metastatic disease, uninsured patients were less likely to receive radiation therapy, though this was not the case in those covered by Medicaid.
The researchers concluded that patients without insurance as well as those with Medicaid had an increased risk of dying from testicular cancer than those with insurance. Future studies should examine whether implementation of the Patient Protection and Affordable Care Act reduces these disparities
The second study, which was led by Judy Huang, MD, Johns Hopkins University (Baltimore, MD), demonstrated similar results. Researchers identified 13,665 patients diagnosed with glioblastoma between 2007 and 2012, and found that patients who were uninsured or covered by Medicaid were more likely to present with larger tumors than insured patients. Medicaid patients also did not receive surgical treatment as often as insured patients while both Medicaid insurance and uninsured status were associated with a lower likelihood of receiving adjuvant radiotherapy. Overall, insured patients survived significantly longer than those who were uninsured or covered by Medicaid.
Further, researchers also noted that, since survival seemed to increase over time only for non-Medicaid insured patients, it is likely that improvements in medical therapies have not been made as easily accessible to uninsured or Medicaid-insured patients.
They concluded that uninsured status and Medicaid insurance may result in shorter survival compared with non-Medicaid insured patients with glioblastoma.
In an accompanying editorial, Michael Halpern, MD, Temple University (Philadelphia, PA), and Otis Brawley, MD, of the American Cancer Society and Emory University in Atlanta, wrote that "while much of today's research focuses on basic understanding of cancer and the development of new treatments, diagnostics, and molecular markers, studies such as these are important if we are to truly address the cancer problem."
They added that "adequate healthcare should be considered an inalienable human right, and greater emphasis is needed on realizing strategies that will make this happen throughout the continuum of cancer care."
