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2017 ; 22
(3
): 351-358
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gab.com Text
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Population-Level Differences in Rectal Cancer Survival in Uninsured Patients Are
Partially Explained by Differences in Treatment
#MMPMID28220019
Pulte D
; Jansen L
; Brenner H
Oncologist
2017[Mar]; 22
(3
): 351-358
PMID28220019
show ga
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. The Oncologist 2017;22:351-358
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.