Survival Analysis of Cancer Patients of Differing Payer Type in South West Virginia, Between 2000 and 2013

Abstract

IntroductionThe effect of insurance coverage on the health of at-risk populations is poorly understood in the Appalachian region of the United States. The goal of this study is to examine how different types of insurance coverage (Private Insurance, Medicare under 65, Medicare 65 or over, Medicaid and Self Pay) may influence cancer survival over time. This study analyzes colon, bladder, as well as combines anal, rectal, and esophageal cancers.MethodsWe systematically analyzed all West Virginia Cancer Registry patients between the years of 2000 and 2013 who was diagnosed with colon, bladder, anal, rectal, and esophageal cancers. Separate analysis examined colon (n = 927), bladder (n = 269), and combined anal, rectum, and esophageal cancers (n = 398). Cox proportional hazards models investigated the effect of insurance types on survival while controlling for age, sex, tobacco use, alcohol use, and cancer stage.ResultsOverall, tobacco use marginally significantly decreased colon cancer survival. Tobacco use had a suggestive relationship at hazards ratio at 1.150, 95% confidence interval: 0.9990-1.235, p = 0.052. The type of payer group did not alter survival. Older individuals tend to have a lower survival rate compared to those that are younger at the time of diagnosis. Also, late-stage cancer faced lower survival compared to those with early-stage cancer. Other results within stage groups corresponded to existing literature.ConclusionFor the three differing cancer groupings, there was no significant survival difference for patients by insurance type. The effect of tobacco usage on colon cancer survival merits further research. The study design could be improved by considering more risk factors such as patient comorbidities that might affect patient care and survival.

Insurance Status in Rectal Cancer is Associated With Age at Diagnosis and May be Associated With Overall Survival

“…10 Annie et al performed a retrospective review of cancer registries looking at insurance status as it related to the colon, bladder, anal, rectal, and esophageal cancers and concluded that the payer type did not alter survival. 5 This study assessed multiple different cancer types (anal, rectal, and esophageal were all combined into 1 cohort) which make the conclusions difficult to apply to a subset; however, it was the first of its kind to deem that the payer source did not affect survival. Pulte et al specifically looked at rectal cancer patients’ survival as it related to insurance status and stated that decreased survival may be associated with differences in treatment.…”

“…It is unclear as to why this occurs at younger ages in uninsured patients; however, it may be related to environmental risk factors, such as smoking, or dietary habits. 3,5 In addition, factors such as access to healthcare are likely to play a role. 7 Further research is warranted to determine the socioeconomic and other environmental factors that may play a role in early diagnosis for these patients.…”

“…4 NCRT is indicated for T3/T4 tumors and includes patients with T1/T2 lesions and patient with clinically positive nodes, which is generally stage II cancers and beyond. 5,6 The 5-year survival rate of rectal cancer is 64% overall, but the survival rate of patients with regional and distant disease is 71% and 14%, respectively. 7 Previous studies have shown decreased survival with uninsured patients with colon cancer.…”

“…4 NCRT is indicated for T3/T4 tumors and includes patients with T1/T2 lesions and patient with clinically positive nodes, which is generally stage II cancers and beyond. 5,6…”

The Relationship between 5-year Overall Survival Rate, Socioeconomic Status and SEER Stage for Four Target Cancers of the National Cancer Screening Program in Korea: Results from the Gwangju-Jeonnam Cancer Registry

“…특히 낮은 사회경제적 수준은 암 조기검진 및 진단, 치료, 삶의 질, 생존율과도 관련성이 있었다 [6]. 사회경제적 수준은 환자에게 투여되는 암 치료의 유형과 치료 기간에 영향을 미칠 수 있으며 [7], 특히 소득수준이 낮은 집단의 경우 암 치료 과정 에서 발생하는 불평등으로 인해 암 생존율이 상대적으로 낮을 것으로 보인다 [8]. 사회경제적 수준이 낮으면 의료 시설에 대 한 접근이 제한되기 때문에 정기적으로 암 검진을 받을 가능성 이 적으며 [9], 사회경제적 수준이 낮은 암 환자는 진단 당시 진 행성 암의 위험이 더 높았다 [10].…”