In one study of testicular germ cell cancer, which usually afflicts
young men, 10 percent of patients were uninsured and 13 percent had
Medicaid. They were 26 percent and 62 percent, respectively, more
likely than men with other insurance to have metastatic disease -
cancer that had spread by the time it was diagnosed. They were also
less likely to undergo lymph node dissection.
“The thought is, and the data support, that patients are presenting
with more advanced disease if they don’t have insurance,” senior
author Christopher Sweeney of the Dana-Farber Cancer Institute in
Boston told Reuters Health. “This would suggest that they are
delaying their presentation, presumably because they have a fear of
seeing a doctor because of the financial implications.”
There are almost 9,000 new diagnoses of testicular cancer each year
in the U.S., affecting men at an average age of 33, according to the
American Cancer Society.
In Sweeney and colleagues’ study of more than 10,000 men diagnosed
with testicular cancer between 2007 and 2011, uninsured men also had
an 88 percent higher risk of death from the disease than those with
insurance, according to the results in the journal Cancer.
In the second study, senior author Dr. Judy Huang of the Johns
Hopkins University School of Medicine in Baltimore and her
colleagues identified almost 13,700 new cases of malignant brain
tumors called glioblastoma between 2007 and 2012. Of these patients,
4 percent were uninsured, 11 percent had Medicaid and the rest had
other insurance coverage.
Being uninsured or having Medicaid coverage was associated with
shorter survival time, as was older age, male sex and larger tumor
“We have found that non-Medicaid insured patients have a significant
survival benefit over uninsured and even Medicaid insured patients,”
said Dr. Wuyang Yang, a research fellow at Johns Hopkins Hospital
and coauthor of the study.
“Within the context of the current study, we cannot confirm the
underlying reason for these associations,” Yang told Reuters Health
by email. “However, as previous studies that investigated insurance
status and survival in other types of cancers have suggested, one of
the potential reasons might be the disparity in healthcare access in
patients with different insurance types.”
In addition, Yang said, the researchers think insurance status is an
indirect indicator of the glioblastoma patients’ socioeconomic
status and having “sufficient socioeconomic support . . . might be
critical for the outcomes of these patients.”
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There were almost 23,000 new cases of brain or nervous system cancer
in the U.S. in 2015 and glioblastoma accounts for 17 percent of
brain cancers, according to the National Cancer Institute.
Glioblastoma tends to occur in adults between ages 45 and 70 years.
It’s not clear from these studies if insurance status is also
related to outcomes in other diseases, Yang noted.
“The provision of adequate care for all individuals diagnosed with
cancer has the potential to save thousands of additional lives per
year,” Michael T. Halpern of the Temple University College of Public
Health in Philadelphia and Otis W. Brawley of the American Cancer
Society and Emory University in Atlanta write in an editorial
accompanying the two studies.
“The underserved deserve service,” Halpern and Brawley write.
“Adequate health care should be considered an inalienable human
right, and greater emphasis is needed on realizing strategies that
will make this happen throughout the continuum of cancer care.”
The Affordable Care Act is increasing access to preventive
early-action healthcare, so these trends could change in coming
years, Sweeney said. “Some benefits are already being seen under the
For patients, “the issue is, don’t avoid evaluating symptoms because
of fear of cost,” he said. Urgent care centers that see uninsured
patients may be a good option, he said.
“For policymakers it’s very concerning and should be sorted out,”
SOURCE: http://bit.ly/2beHHDG , http://bit.ly/2bHYxOi and http://bit.ly/2b04x5h
Cancer, online August 8, 2016.
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