Study reveals causes of survival disparities based on insurance among rectal cancer patients

June 14, 2010

Disparities in cancer stage and treatment are the main reasons why Medicaid-insured and uninsured rectal cancer patients are twice as likely to die within five years as privately insured patients. That is the conclusion of a new study published early online in Cancer, a peer-reviewed journal of the American Cancer Society. Because poorer survival among rectal cancer patients without private insurance is largely attributable to later cancer stage at diagnosis and inadequate treatment, disparities may be lessened through health care reform.

A number of factors may account for survival disparities seen among patients with colorectal cancer. The likelihood that these patients might die prematurely may be influenced by and treatment, health insurance status, and demographic factors such as age, sex, race/ethnicity, and poverty status. To explore the relative contribution of such factors on survival disparities, Anthony S. Robbins, MD, PhD, of the American Cancer Society in Atlanta and his colleagues conducted a study of insurance status and survival among 19,154 patients aged 18 to 64 years, using data from the National Cancer Data Base, a national hospital-based cancer registry. Patients were diagnosed in 1998 to 2002 and were followed through 2007. (The investigators restricted the study to rectal cancer rather than all colorectal cancer because it is staged and treated differently than colon cancer, and previous research on rectal cancer is more limited than research on .)

Dr. Robbins and his team examined the impact of 10 factors on 5-year survival: age, sex, race/ethnicity, cancer grade, cancer subtype, neighborhood education and income levels, treatment facility type, cancer stage, and treatment. After adjusting only for age, the researchers found that Medicaid-insured and uninsured patients had twice the risk of privately insured patients of dying within five years. After adjusting for all of the factors listed above, the investigators determined that rectal cancer patients insured through Medicaid had a 34 percent increased risk of dying within five years compared with privately insured patients. Uninsured patients had a 29 percent increased risk of dying within five years compared with privately insured patients. Disparities in cancer stage and treatment accounted for approximately 53 percent of the excess deaths, while factors other than stage and treatment accounted for approximately 17 percent.

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

More information: "Insurance status and survival disparities among non-elderly rectal cancer patients in the national cancer data base." Anthony S. Robbins, Amy Y. Chen, Andrew K. Stewart, Charles A. Staley, Katherine S. Virgo, and Elizabeth M. Ward. Cancer; Published Online: June 14, 2010. DOI: 10.1002/cncr.25317

Related Stories

Recommended for you

'Bet hedging' explains the efficacy of many combination cancer therapies

December 14, 2017
The efficacy of many FDA-approved cancer drug combinations is not due to synergistic interactions between drugs, but rather to a form of "bet hedging," according to a new study published by Harvard Medical School researchers ...

Scientists unlock structure of mTOR, a key cancer cell signaling protein

December 14, 2017
Researchers in the Sloan Kettering Institute have solved the structure of an important signaling molecule in cancer cells. They used a new technology called cryo-EM to visualize the structure in three dimensions. The detailed ...

Liquid biopsy results differed substantially between two providers

December 14, 2017
Two Johns Hopkins prostate cancer researchers found significant disparities when they submitted identical patient samples to two different commercial liquid biopsy providers. Liquid biopsy is a new and noninvasive alternative ...

Testing the accuracy of FDA-approved and lab-developed cancer genetics tests

December 14, 2017
Cancer molecular testing can drive clinical decision making and help a clinician determine if a patient is a good candidate for a targeted therapeutic drug. Clinical tests for common cancer causing-mutations in the genes ...

Newest data links inflammation to chemo-brain

December 14, 2017
Inflammation in the blood plays a key role in "chemo-brain," according to a published pilot study that provides evidence for what scientists have long believed.

One in five young colon cancer patients have genetic link

December 13, 2017
As doctors grapple with increasing rates of colorectal cancers in young people, new research from the University of Michigan may offer some insight into how the disease developed and how to prevent further cancers. Researchers ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.