Health Insurance and Quality of Cancer Treatment

Evidence-based treatment guidelines exist for almost all common types of cancer. However, many studies have noted disparities in the receipt of guidelines-based treatment, often along lines such as race, economic status, and age. A study by NCI's Division of Cancer Control and Population Sciences (DCCPS) published in the December 20 Journal of Clinical Oncology examined whether the receipt of guidelines-based treatment is also affected by the type of medical insurance held by patients. The study was based on a sample of more than 7,000 patients identified through the Surveillance, Epidemiology, and End Results (SEER) registries.

The investigators examined the association between treatment received and insurance status - private insurance, any Medicaid, Medicare only, or no insurance - for 10 common cancers with established evidence-based treatment guidelines. They also adjusted for other clinical and non-clinical factors such as cancer stage at diagnosis, comorbidities, age, race, and marital status.

Levels of guidelines-based treatment proved to be lower than expected for all groups, but were significantly lower for patients who depended on Medicare or Medicaid alone for insurance. Also of particular note is that non-Hispanic black patients with Medicaid were significantly less likely than other groups to receive guidelines-based treatment, with only half receiving recommended therapy.

The investigators concluded that health insurance is one of many important variables that influence the receipt of guidelines-based therapy. In a follow-up study, they plan to examine how insurance status affects survival after cancer diagnosis. Source: US NCI

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