Open AccessPopulation‐Level Differences in Rectal Cancer Survival in Uninsured Patients Are Partially Explained by Differences in Treatment
Author(s) -
Pulte Dianne,
Jansen Lina,
Brenner Hermann
Publication year - 2017
Publication title -
the oncologist
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.176
H-Index - 164
eISSN - 1549-490X
pISSN - 1083-7159
DOI - 10.1634/theoncologist.2016-0274
Subject(s) - medicaid , medicine , population , survival analysis , epidemiology , demography , health care , environmental health , economics , sociology , economic growth
Background Rectal cancer (RC) is a common malignancy with a substantial mortality but good survival for patients with optimally treated nonmetastatic disease. Lack of insurance may compromise access to care and therefore compromise survival. Here, we examine RC survival by insurance type. Methods Data from the Surveillance, Epidemiology, and End Results database were used to determine 1‐ to 3‐year survival for patients with RC by insurance type (Medicaid, uninsured, other insurance). Results Patients with Medicaid or no insurance presented at later stages and were less likely to receive definitive surgery. Overall 3‐year survival was higher for patients with other insurance compared with Medicaid‐insured (+22.2% units) and uninsured (+18.8% units) patients. Major differences in survival were still observed after adjustment for stage. When patients with stage II and III RC were considered, 3‐year survival was higher for patients with other insurance versus those with Medicaid (+16.2% units) and uninsured patients (+12.2% units). However, when the analysis was limited to patients with stage II and III disease who received radiation therapy followed by definitive surgery, the difference decreased to +11.8% units and +7.3% units, respectively, for Medicaid and no insurance. Conclusion For patients with stage II and III RC, much of the difference in survival between uninsured patients and those with insurance other than Medicaid can be explained by differences in treatment. Further efforts to determine the cause of residual differences as well as efforts to improve access to standard‐of‐care treatment for uninsured patients may improve population‐level survival for RC. Implications for Practice Insurance status affects survival for patients with rectal cancer, but a substantial proportion of the difference in survival can be corrected if standard‐of‐care treatment is given. Every effort should be made to ensure that uninsured or publically insured patients receive standard‐of‐care treatment with as little delay as possible to improve patient outcomes.