Cancer Patients on Medicaid Fare Worse

August 4, 2014
Dave Levitan
Dave Levitan

Patients with Medicaid coverage or no insurance at all were more likely to present with advanced cancer of a number of types, and were also less likely to receive certain treatments, according to a study using the SEER database.

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Previous studies on disparities in care and outcome based on insurance status have been focused on individual malignancies and in only select populations. The new study, led by Usama Mahmood, MD, of MD Anderson Cancer Center in Houston, used the SEER database of the National Cancer Institute to look for disparities in care in patients with any of the 10 deadliest cancers. Results were published online ahead of print today in the Journal of Clinical Oncology.

The study included 473,722 patients between the ages of 18 and 64 who were diagnosed with one of those 10 deadliest cancers between 2007 and 2010. Most of the patients (78.4%) had non-Medicaid insurance, while 11.6% had Medicaid and 4.7% were uninsured. In the full cohort, patients with non-Medicaid insurance were less likely to present with distant disease (16.9%) than those with Medicaid coverage (29.1%) or with no insurance coverage at all (34.7%; P < .001).

Treatments were also different based on insurance coverage. Patients with non-Medicaid insurance coverage underwent cancer-directed surgery and/or radiotherapy 79.6% of the time, compared to 62.1% of those with no insurance coverage (P < .001); Medicaid patients received such treatments 67.9% of the time.

Unsurprisingly given the differences in treatment and disease status at presentation, there was also a significant difference in cause-specific survival outcomes. The 2-year cause-specific survival among those with non-Medicaid coverage was 86.2%, compared with only 69.1% in Medicaid patients and 66.5% in those with no insurance (P < .001). Adjustment for numerous factors showed that patients were more likely to die of the disease if they had Medicaid (hazard ratio [HR] = 1.44; 95% CI, 1.41-1.47; P < .001) or if they had no insurance at all (HR = 1.47; 95% CI, 1.42-1.51; P < .001).

The study authors noted estimates that the Affordable Care Act could result in up to a 70% reduction of underinsured individuals and a 60% drop in uninsured people. “Expanded access to insurance coverage and expanded services available through participating state Medicaid plans will likely affect cancer care,” they wrote.

Still, they acknowledge that other barriers to care may exist as well, such as lack of access to transportation or poor social support. Further research is also still needed, including to what degree poor outcomes in Medicaid patients are attributable to patient-, tumor-, or treatment-related factors.