FRIDAY, Aug. 8, 2014 (HealthDay News) -- A new U.S. study finds
that cancer patients who don't have insurance -- or who get it
through the federal health insurance program for the poor
(Medicaid) -- are at much higher risk of poor medical outcomes than
They're more likely to have advanced cancer when they're
diagnosed, less likely to be treated with surgery or radiation and
more likely to die of their disease, researchers report.
The findings don't explain the discrepancies, and they don't say
anything about how health care reform might change the fates of
poor patients with cancer. Still, they offer a worrisome picture of
the American health care system in the years right before the
Affordable Care Act, or Obamacare, as some call it, was passed.
"We were surprised to find that patients without insurance were twice as likely as those with insurance to present with cancer that's spread from the place where it first started," said study author Dr. Gary Walker, a radiation oncologist at the University of Texas MD Anderson Cancer in Houston. "Even when adjusting for many different factors, patients were still more likely to die if they had Medicaid coverage or no insurance."
In fact, up to 33 percent of the cancer patients without
insurance or with Medicaid died within two years of diagnosis,
compared to just 14 percent of those with other kinds of
The study authors launched their research because there's little
information about how having insurance affects the diagnosis and
treatment of cancer, Walker said.
The researchers examined national cancer statistics from 2007 to
2010 for people aged 18-64; all the patients suffered from at least
one of the 10 deadliest types of cancer. The study focuses on the
insurance status of the cancer patients and their diagnosis,
treatment and fate during the three-year period.
Overall, about three-fourths received treatment through surgery,
radiation or both. Only 62 percent of the uninsured received those
types of treatments, compared to 68 percent of those with Medicaid
and 80 percent of those with other kinds of insurance.
"Patients without insurance often times are forced to wait until their symptoms are very advanced before seeing a doctor, and patients without Medicaid or private insurance typically cannot afford costly surgery, radiation therapy and chemotherapy," explained study co-author Dr. Usama Mahmood, an assistant professor with the department of radiation oncology at Anderson. "And there may be other social factors that hinder their ability to receive cancer care."
Dr. Karl Bilimoria, director of the Surgical Outcomes and
Quality Improvement Center at Northwestern University's Feinberg
School of Medicine in Chicago, added that waiting to see a doctor
until cancer is advanced may translate to less surgery or
radiation. "If the stage of disease is more advanced, these
therapies may no longer be as crucial as systemic therapies such as
chemotherapy," he said.
As for deaths from cancer, the researchers adjusted the
statistics so they wouldn't be thrown off by factors like high or
low numbers of patients who were of certain genders, ages, races
and other traits. They found that those on Medicaid or without
coverage were still 44 percent to 47 percent more likely to die of
cancer over two years.
In the big picture, Bilimoria said, the results aren't
surprising: "We have seen these results many times before." But
they're still important because "it is critical to ensure that all
patients are treated fairly and receive the best possible care," he
Under health care reform, it is much easier for many people to
get insurance and some states are expanding the number of poor
people who are eligible to get coverage through Medicaid. Many
plans are required to offer colorectal cancer screening for people
The expansion of insurance "has provided millions more Americans
access to insurance, and could perhaps improve the survival of
those patients who develop cancer," study co-author Mahmood
Still, "we need to be sure that we are not only offering people
insurance but also that it is a useful form of insurance that
allows them access to care and, more importantly, access to timely
cancer care," Bilimoria said.
The study was published online Aug. 4 in the
Journal of Clinical Oncology.
For more about health care reform, try the federal government at
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