Cancer Patients Without Insurance Had Higher Death Rate, Studies Find

Having no insurance or getting it post-diagnosis worsened outcomes, study said.

ByABC News
August 9, 2016, 7:41 AM
Chemotherapy is administered to a cancer patient at Duke Cancer Center in Durham, North Carolina, Sept. 5, 2013.
Chemotherapy is administered to a cancer patient at Duke Cancer Center in Durham, North Carolina, Sept. 5, 2013.
Gerry Broome/AP Photo

— -- The importance of health insurance for cancer patients was again made clear in two new studies, which found that those with the disease had an increased risk of dying from it when they lacked health coverage.

Both studies highlighted how preventive care, which people with health insurance receive more often, can affect survival rates for cancer patients. If the disease is caught early, patients have far better survival rates.

"As much as we are making advances in understanding biology and improving treatment for these cancers, early diagnosis and early management is still key and far more important, as this can cure patients," said Dr. Christopher Sweeney, the senior physician at the Dana-Farber Cancer Institute and a co-author of a study examining how medical coverage affected outcomes among testicular cancer patients. "What we can do to improve access to health care is a very important part of the strategies we need to implement."

Researchers at the Dana-Farber/Brigham and Women's Cancer Center looked at 10,211 patients in the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program who had a testicular cancer from 2007 to 2011, for the first study, published in the medical journal Cancer. They focused on patients under 65 and found that 10 percent of the patients studied were uninsured and 13 percent had Medicaid insurance.

The researchers saw a pattern: Uninsured or Medicaid patients had larger tumors or more-advanced disease. The researchers found 44 percent of men withMedicaid and 44 percent of men without insurance were diagnosed with metastatic disease (stage 2 or 3) when the disease was discovered. Ultimately, after controlling for variables, the researchers found that men without insurance had a "26 percent increased risk of being diagnosed with metastatic disease in comparison with men with insurance and those with Medicaid had a more than 60 percent increased risk."

The researches also found that those patients had fewer treatments compared with men who had insurance.

Another study in the same journal showed that 558 brain cancer patients without insurance or with Medicaid insurance also had larger tumors when they got to a doctor and, not surprisingly, shorter survival times. In that study, researchers from the department of neurosurgery at Johns Hopkins University studied 13,665 patients enrolled in the SEER database who were diagnosed with glioblastoma multiforme, a form of brain cancer, from 2007 to 2011.

For patients who had insurance, they found that the survival rate improved each year, with a 19.6 percent two-year survival rate in 2007 and a 23.9 percent two-year survival in 2011. In contrast, no insurance and Medicaid insurance were seen as independent predictors of a shorter survival.

Some patients in these studies who were classified as having Medicaid may have received it after their cancer diagnosis; they may have been uninsured at the time of their diagnosis.

The timing of having health coverage could also be important. Even when newly diagnosed cancer patients were quickly enrolled in Medicaid coverage, it was often after the disease had progressed and worsened their health outcomes before they received treatment, Dr. Otis Brawley, the chief medical officer of the American Cancer Society, said.

"People who have Medicaid who have cancer overwhelmingly get Medicaid within a week of being diagnosed," he said. "They don't have Medicaid when they need the preventive health. They don't have it when they have the early symptoms of cancer."

Brawley pointed out that the studies ended before the Affordable Care Act, which requires Americans to have health insurance or face a fine, was in place. An increase in the number of people who have insurance could lead to earlier detection and treatment for those with cancer.

"When they have early symptoms and might be able to go to the doctor ... with early disease rather than when they are so catastrophic that they have to go to the emergency room," patients fare better, he said.

Aside from finding a cure or new treatments for cancer, scientists and medical professionals "need to do research on how to get the treatments that already exist to the patients that need them," Brawley said.

He said he hoped the findings would spur the public to demand more help for people to get health coverage.

"I wish society would listen to these results," he said, adding that action was needed to help patients get coverage before catastrophic diagnoses. "We don't need more studies to show a lack of health insurance means that you have lack of health care and lack of health care, including preventive health care, means that you die sooner and die in greater distress."

Dr. Kavita Vakharia is a plastic surgery resident at Penn State Hershey Medical Center. She is also a resident with the ABC News Medical Unit.