Insurance Status Affects Outcomes for Patients With Cancer

Health insurance status can have a big impact on a person’s health outcomes after they are diagnosed with cancer, according to new research published in CANCER. Two different studies examined disparities in 2 cancers: testicular germ cell tumors and glioblastoma.

In the testicular germ cell tumor study, researchers, led by Christopher Sweeney, MBBS, of the Dana-Farber Cancer Institute, found that being uninsured or having Medicaid coverage was associated with a variety of disparities compared with patients with other forms of insurance.

"Although testis cancer is curable with chemotherapy, this study supports the notion that lack of insurance may lead to delays in diagnosis and more advanced and less curable disease," Sweeney said in a statement. "Our findings support the belief that early diagnosis and management is key, and removal of barriers to access to health care should be implemented."

Patients with Medicaid or without insurance were more likely to be diagnosed at a later stage, received less-than-optimal treatment, and had shorter survival times. The researchers used data on 10,211 men diagnosed with germ cell gonadal neoplasms from 2007 to 2011.

“Patients without insurance and patients with Medicaid have an increased risk of presenting with advanced disease and dying of the disease in comparison with those who have insurance,” the authors concluded.

They suggest that future studies examine whether the implementation of the Affordable Care Act, and the resulting coverage expansion, reduces disparities.

In the glioblastoma study, researchers, led by Judy Huang, MD, of the Johns Hopkins University School of Medicine, analyzed claims for 13,665 patients diagnosed between 2007 and 2012. They found that being uninsured or having Medicaid suggested a shorter survival for patients diagnosed with glioblastoma compared with patients that had non-Medicaid insurance. Patients with insurance other than Medicaid experiences and improvement in survival over time, which was not true for Medicaid patients and the uninsured.

"This suggests that while improvements in medical therapy have resulted in longer survival, this benefit is less likely to be accessible to Medicaid-insured or uninsured patients," said Huang.

The researchers also found that Medicaid patients were less likely to receive surgical treatment and that these same patients, as well as those without insurance, were less likely to receive adjuvant radiotherapy. Patients who were uninsured or had Medicaid are also more likely to present with larger tumors compared with patients with other insurance.

"This study indicates significant disparities in the management of glioblastoma patients under our existing healthcare insurance framework that need to be addressed," said Wuyang Yang, MD, MS, co-lead author of the study.