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Uninsured with Rectal Cancer are More Likely to Die

Insurance makes a difference for people with rectal cancer.

Rectal cancer patients without insurance or covered by Medicaid are almost twice as likely to die within five years as those privately insured.

Not only are they diagnosed at a later stage, but fewer receive recommended treatments at every stage.

More than half of the difference between patients with private insurance and those without was due to differences in how early they were diagnosed and whether or not they got standard treatment.

Researchers looked at information from the National Cancer Data Base, a national hospital-based cancer registry, to study insurance and other factors related to survival among 19,154 rectal cancer patients aged 18 to 64 years old.

They analyzed the impact of  insurance, age, sex, race and ethnicity, neighborhood education and income levels, cancer treatment facility type, stage, pathology features, and treatment on survival at five years.

Rectal cancer patients were diagnosed between 1998 and 2002, and their progress was followed until 2007.

Results

  • Uninsured patients were diagnosed at Stage I (17.6 percent) less often than those with private insurance (31 percent).
  • Uninsured were diagnosed at late Stage IV (22.5 percent) more often than privately insured (13.8 percent).
  • Uninsured were twice as likely not to have a high school diploma (38.9% versus 19.9%) and be poor (44.8 percent vs. 24.1%).
  • Patients with private insurance were more likely to be treated in comprehensive community cancer centers, while patients with no insurance were more likely to be treated in teaching/research hospitals.

Differences in standard treatment

  • Stage I:  95.1 percent of private patients had surgery with or without chemo/radiation  compared to  83.4 percent of uninsured.
  • Stage II:  91.4 percent of privately insured had recommended surgery with or without chemo/radiation while 79.4 percent of uninsured did.   7.7 percent of private patients had chemo/radiation but no surgery compared to 19.2 percent of uninsured.
  • Stage III:  4.7 percent of private patients had chemo/radiation without surgery while twice as many (9.6 percent) of uninsured patients received this substandard treatment.
  • Stage IV:  More than 3 times as many uninsured patients (14.8 percent) had no treatment at all compared to 4.4 percent of those with insurance.  Again, uninsured patients got less surgery (42.2 percent) than those with insurance coverage (60 percent).

Writing in an early online edition of Cancer, Anthony S. Robbins, MD, PhD and his team in the Department of Surveillance and Health Policy Research at the American Cancer Society said,

Our main finding that most of the excess mortality seen among Medicaid-insured and uninsured patients was explained by 2 modifiable factors (stage and treatment) suggests that improving insurance coverage and reducing cost-related barriers to primary care, CRC screening, and high-quality treatment would have a major impact on CRC survival disparities.

SOURCE: Robbins et al., Insurance status and survival disparities among nonelderly rectal cancer patients in the National Cancer Data Base, Cancer, Early View, June 2010.

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