New Report Underscores Importance of Health Insurance Status and Cancer Stage at Diagnosis and Survival

A new report led by researchers atthe American Cancer Society (ACS) shows individuals without health insurance coverage were significantly more likely

to be diagnosed with late-stage cancer and have worse survival rates after cancer diagnosis compared to individuals with private health insurance. The study also showed for six cancers—prostate, colorectal, non-Hodgkin lymphoma, oral cavity, liver, and esophagus—uninsured individuals diagnosed with Stage I disease had worse survival rates than individuals with private health insurance coverage diagnosed with Stage II disease. The findings were published today in CA: A Cancer Journal for Clinicians.

“Our findings extend earlier research showing that lack of health insurance coverage is associated with later stage at diagnosis and worse short-term survival among individuals newly diagnosed with cancer, with more recent data and more information on long-term survival,” said Jingxuan Zhao, senior associate scientist at the American Cancer Society and lead author of the study. “Improving access to comprehensive health insurance coverage is critical for ensuring access to care throughout the cancer care continuum, including receipt of recommended cancer screening, timely diagnosis, and quality treatment.”

Researchers used data from the U.S. National Cancer Database (NCDB), a nationwide, hospital-based cancer registry jointly sponsored by the ACS and the American College of Surgeons.The NCDB includes about 70% of all newly diagnosed cancer cases in the U.S. from more than 1500 facilities accredited by the American College of Surgeons’ Commission on Cancer. The NCDB contains patient information on demographic characteristics, tumor characteristics, health insurance coverage, and vital status. Study authors included individuals 18–64 years old, newly diagnosed with cancer between 2010 through 2013, with any of 19 common invasive cancers.

The analysis showed people without health insurance coverage were more likely to have a later-stage cancer diagnosis than people with private health insurance coverage. Also, people without health insurance coverage were more likely to have worse short- and long-term survival rates after a cancer diagnosis than people with private health insurance coverage.

Compared to privately insured individuals diagnosed with Stage II cancer, uninsured individuals diagnosed with Stage I cancer had worse survival rates for 6 cancer sites - prostate, colorectal, non-Hodgkin lymphoma, oral cavity, liver, and esophagus. In multivariable analyses, individuals without health insurance had worse survival than their privately insured counterparts within each stage for all the 19 cancers combined and for 14 of 19 cancer sites.

“Our study adds to the accumulating evidence showing access to comprehensive health insurance coverage is crucial to improving cancer care and outcomes,” said Dr. William Dahut, chief scientific officer at the American Cancer Society. “People should not have to suffer worse survival rates or a later stage diagnosis because they can’t afford treatment.”

Dr. Robin Yabroff is senior author of the study. Other ACS authors include: Dr. Xuesong Han, Dr. Leticia Nogueira, and Dr. Ahmedin Jemal.

Resources from the American Cancer Society concerning health insurance coverage can be found here.

Guideline URL: https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/caac.21732