Government-Insured Patients With Breast Cancer Face a Higher Risk of Death

Patients with breast cancer who have government insurance face a higher risk of death, according to a retrospective study presented at the 2019 San Antonio Breast Cancer Symposium on December 13.

The study, conducted by researchers in the ECOG-ACRIN Cancer Research Group, looked at 9800 women diagnosed with breast cancer who participated in randomized clinical trials. Patients enrolled in 2 separate chemotherapy treatment trials between 1999 and 2002 (study E1199) and between 2007 and 2011 (study E5103) were included.

“Having insurance in and of itself was not enough to ensure access to a clinical trial or a good clinical outcome,” said Samilia Obeng-Gyasi, MD, the lead researcher of the study.

Each patient’s neighborhood socioeconomic status was also evaluated. Researchers linked zip codes to county-level data on occupation, income, poverty wealth, education, and crowding. However, the study found this status was not associated with trial completion or survival.

Overall, patients with Medicare and Medicaid were “much less likely to participate in a clinical trial compared to their privately insured counterparts.” The women covered by the government who did participate in the trials were more likely to stop their treatment earlier and had lower survival rates.

The majority of women included in the studies had private insurance, while only about 13% of the patients received government insurance. According to researchers, 1 out of every 4 patients with government coverage in E1199 did not complete treatment, compared with 1 out of every 7 privately insured women. In the second study, E5103, “approximately 1 out of every 2 government insured patients did not complete therapy compared to 1 out of every 3 privately insured patients.”

In addition, in E1199 the risk of death of government insured patients increased by one-half while in E5103 that risk increased by one-third.

“With continued changes to insurance at the federal and state levels, physicians and policy makers would benefit from having more data such as what we produced in our study,” said Obeng-Gyasi, highlighting the importance of the research.

Obeng-Gyasi studies social determinants of cancer care as a breast surgical oncologist at The Ohio State University.

“Right now, most clinical trials do not collect data on social determinants of health. If they did, the information could lead us to better understand the interaction of insurance status and many other factors on the clinical outcomes of clinical trial participants,” she said.

Reference

Obeng-Gyasi S, O’Neil A, Zhao F, et al; ECOG-ACRIN Cancer Research Group. Breast cancer patients with government insurance at higher risk of death. Presented at: San Antonio Breast Cancer Symposium; December 13, 2019; San Antonio, TX. Abstract PD10-09.