Type of Health Insurance and Marital Status Affect Outcomes in Liver Cancer

People treated for liver cancer at an inner-city hospital experienced better survival odds if they had private health insurance, and also if they were married, according to the results of a recent study that considered how socioeconomic factors affect health outcomes for those with the disease.

Patients with private insurance lived 30 percent longer than those with Medicaid (government coverage based on financial need) and 20 percent longer than those with Medicare (government coverage for Americans 65 and older), according to multivariate Cox proportional analysis. Meanwhile, married patients survived 40 percent longer than those who had never tied the knot, the researchers from Yale University found.

One unifying theme was that people who received cancer-directed treatments — those aimed at curing and controlling cancer — had better outcomes. Another was that older patients experienced worse overall survival (OS).

Lead researcher Cortlandt Sellers, a candidate for a medical degree at Yale School of Medicine, presented the findings Jan. 19 during the Gastrointestinal Cancers Symposium hosted by the American Society of Clinical Oncology in San Francisco.

“Primary insurance and social support appear to affect the OS of patients with HCC,” wrote Sellers and her colleagues.

Included in the study were nearly 1,000 patients listed in a registry of people diagnosed with hepatocellular carcinoma (HCC) between 2005 and 2016. Seventy-nine percent of them were male, with a mean age of 62.8 years. Twenty-five percent of those studied had private insurance, 38 percent were insured through Medicare and 34 percent relied on Medicaid.

Those with private insurance had a median OS of 27.8 months, while those with Medicare survived a median 21 months and those with Medicaid 13.3 months, the researchers reported.

Outcomes for people with different stages of the disease showed stark differences when broken down by insurance type. Median OS in stage 2 was 55.3 months for those who had private insurance, 26 months for those with Medicare and 13.2 months for patients with Medicaid. In stage 3 HCC, private insurance was associated with a median OS of 23.8 months, Medicare with a median OS of 14.6 months and Medicaid with a median OS of 6.7 months. No insurance-based outcome differences were seen in stages 1 or 4, the researchers wrote.

The percentage of patients who received cancer-directed treatments also differed based on insurance type. Ninety-one percent of those with private insurance got such treatments, as did 84 percent of patients with Medicare and 78 percent of the participants who used Medicaid.

Most of the patients in the study (76 percent) were married. As a group, their median OS was 23.7 months, compared with 5.2 months for never-married participants.

What might explain these disparities? The researchers found that 87 percent of the married people in the study used cancer-directed treatments, while 77 percent of never-married participants went that route. The team also found insurance-based differences between the married and never-married groups: 18 versus 49 percent, respectively, had Medicaid; 40 versus 21 percent had private insurance; and 42 versus 30 percent had Medicare.

Also notable was that patients with Medicare had a higher average age (69 years) compared with those who had private insurance (59.6 years) and those insured through Medicaid (57.1 years).

No differences in OS were seen based on ethnicity or gender.

“Patients at an inner-city institution tend to present with advanced-stage liver disease and less social support,” the authors wrote. “This correlates with worse outcomes. Further investigations to elucidate the socioeconomic determinants to enhance survivals are warranted.”