Here's how insurance status affects cancer survival

Men with testicular cancer, who were uninsured or on Medicaid, had a higher risk of death from what is normally a curable disease than insured patients, suggests two new studies.

Many studies have revealed barriers to cancer care associated with health insurance status. Using population-based data from the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute, these latest studies look at two cancers in particular: testicular germ cell tumors and glioblastoma.

In the testicular cancer study, a team led by Christopher Sweeney of the Dana-Farber Cancer Institute in Boston, identified 10,211 men diagnosed with testicular cancer between 2007 and 2011. The researchers found that uninsured and Medicaid-covered patients had an increased risk of having larger testicular cancer tumors or metastatic disease at the time of diagnosis, and they were more likely to die from their disease compared with men with insurance.

Among patients with metastatic disease, those who were uninsured or had Medicaid coverage were more likely to have cancer categorized as "intermediate" or "poor" (rather than "good") risk. Among patients with early stage disease, both uninsured and Medicaid patients were less likely to have lymph nodes removed, a procedure that can cure some patients. Among patients with advanced disease, uninsured (but not Medicaid) patients were less likely to receive radiation therapy.

"Although testis cancer is curable with chemotherapy, this study supports the notion that lack of insurance may lead to delays in diagnosis and more advanced and less curable disease," said Sweeney. "Our findings support the belief that early diagnosis and management is key, and removal of barriers to access to health care should be implemented."

In the study related to glioblastoma, which is the most common malignant primary brain tumor in adults, Judy Huang of the Johns Hopkins University School of Medicine and her colleagues identified 13,665 patients diagnosed between 2007 and 2012. Patients who were uninsured or had Medicaid were more likely to present with larger tumors and to die earlier from their disease compared with insured patients. Patients with Medicaid insurance were less likely to receive surgical treatment, while both Medicaid insurance and uninsured status were associated with a lower likelihood of receiving adjuvant radiotherapy.

Only non-Medicaid insured patients experienced an improvement in survival over time, with patients diagnosed in 2012 living longer than those diagnosed in 2007. "This suggests that while improvements in medical therapy have resulted in longer survival, this benefit is less likely to be accessible to Medicaid-insured or uninsured patients," said Huang.

"This study indicates significant disparities in the management of glioblastoma patients under our existing healthcare insurance framework that need to be addressed," added co-lead author Wuyang Yang.

The findings are published early online in the journal CANCER.