Major study links insurance status to advanced stage in multiple cancers

A new American Cancer Society study of twelve types of cancer among more than 3.5 million cancer patients finds uninsured patients were significantly more likely to present with advanced stage cancer compared to patients with private insurance. The study, which appears in the March issue of The Lancet Oncology, is the first to use national data to investigate insurance status and stage of diagnosis for a large number of cancer sites. It finds the strongest association between insurance status and advanced cancer was for cancers that can be detected early by screening or evaluation of symptoms.

For their study, American Cancer Society researchers led by Michael Halpern, M.D., Ph.D., strategic director of health services research, compared insurance status and stage at diagnosis using the National Cancer Database, a hospital-based registry capturing patient information from approximately 1,430 facilities. The database includes information for approximately 73 percent of patients diagnosed with cancer in the U.S. The new analysis included patients in the database between ages 18 and 99 diagnosed with any of 12 cancers between 1998 and 2004.

The study found consistent associations between insurance status and stage at diagnosis across multiple cancer sites. Compared to patients with private insurance, uninsured patients had significantly increased likelihoods of being diagnosed with cancer at more advanced stages. The greatest risk for diagnosis at with moderately advanced cancer (stage II) instead of the earliest stage (stage I) was in colorectal cancer, while the highest risk for diagnosis at the most advanced stage of cancer (stage III/IV) was in breast cancer. Medicaid patients also had significantly increased risks of presenting with more advanced stage disease compared to patients with private insurance for many cancer sites. The greatest increase in risk of more advanced stage diagnosis among both uninsured and Medicaid-insured occurred for cancer sites that are part of routine screening (e.g., breast, colorectal) or sites with symptoms present at early stages (melanoma, urinary bladder).

In contrast, the likelihood of diagnosis at more advanced stages for pancreas or ovary cancer, while higher, was not significant or only marginally significant for uninsured and Medicaid patients compared to privately insured patients. These two sites characteristically present with advanced stage at diagnosis and do not have screening tests or specific symptoms to allow doctors to diagnose them at an early stage.

The authors note that some of the patients who were coded as having Medicaid insurance were likely to have been enrolled after diagnosis, and thus their later stage at diagnosis may not reflect ability to obtain cancer screening and timely diagnosis among individuals with Medicaid coverage but instead, barriers to medical care due to lack of health insurance.

The study also found African American patients were significantly more likely to be diagnosed at a more advanced stage diagnosis for many cancers, indicating that beyond the effects of health insurance, other barriers likely exist for Black patients related to early diagnosis and prompt medical care.

"The findings of this major study are critical, not only for the 47 million Americans who have no health insurance, but also for our nation," said John R. Seffrin, Ph.D., chief executive officer for the American Cancer Society. "The fact is, too many cancer patients are being diagnosed too late, when treatment is harder, more expensive, and has less chance of saving lives. We must begin to remove the barriers that stand in the way of early diagnosis and timely access to medical care if we are to give all cancer patients an equal chance in the fight."

Source: American Cancer Society

Related stories:

Overweight men face higher risk of dying of prostate cancer
(PhysOrg.com) -- Prostate cancer patients who are overweight and have elevated insulin levels are much more likely to die of the cancer than other patients, say researchers at Harvard University and McGill University. Their research is published in the October issue of The Lancet Oncology.
CRC screening before Medicare age could save millions in federal health-care dollars
A screening program for colon cancer in patients starting ten years prior to Medicare eligibility, at age 55 instead of Medicare's 65, would save at least two dollars for every dollar spent, according to a new study presented at the American College of Gastroenterology's 73rd Annual Scientific Meeting in Orlando.
Disparities in head and neck cancer patients
A new analysis finds considerable disparities in survival related to race and socio-economic status among patients with head and neck cancer. Published in the November 15, 2008 issue of Cancer, a peer-reviewed journal of the American Cancer Society, the study indicates that earlier diagnosis and greater access to treatment could improve outcomes for these cancers among African Americans and the poor.
SNM releases new fact sheet on breast cancer and molecular imaging
Coinciding with the observance of Nuclear Medicine Week (October 5 to 11) and National Breast Cancer Awareness Month (October), SNM released today a new fact sheet highlighting recent developments in molecular imaging technologies that are dramatically improving the ways in which breast cancer is diagnosed and treated.
SNM releases new fact sheet on breast cancer and molecular imaging
Coinciding with the observance of Nuclear Medicine Week (October 5 to 11) and National Breast Cancer Awareness Month (October), SNM released today a new fact sheet highlighting recent developments in molecular imaging technologies that are dramatically improving the ways in which breast cancer is diagnosed and treated.
SNM releases new fact sheet on breast cancer and molecular imaging
Coinciding with the observance of Nuclear Medicine Week (October 5 to 11) and National Breast Cancer Awareness Month (October), SNM released today a new fact sheet highlighting recent developments in molecular imaging technologies that are dramatically improving the ways in which breast cancer is diagnosed and treated.
New catheter-less technique may ease the pain and discomfort of prostate cancer recovery
To ease the pain of recovery following prostate cancer surgery, physician-scientists have developed an innovative and patient-friendly approach that eliminates the use of a penile urinary catheter. The new patentable technique, used in conjunction with robotic prostatectomy -- the surgical removal of the prostate -- eliminates the pain and discomfort associated with the standard catheter.
Study shows radiation device may customize therapy, enable some to avoid more lengthy treatment
A study of the first approximately 100 patients who have received partial breast irradiation with a small, whisk-like, expandable device inserted inside the breast has shown that after one year, the device is effective at sparing nearby healthy tissue from the effects of radiation. The device, called SAVI™, is aimed at providing customized radiation therapy while minimizing exposure to healthy tissue around the breast after a woman has received a lumpectomy for early stage cancer.

News discussion:

Medicine & Health news