The effect of health insurance status on the treatment and outcomes of patients with colorectal cancer

Parikh, Alexander A.; Robinson, Jamie R.; Zaydfudim, Victor M.; Penson, David F.; Whiteside, Martin

doi:10.1002/jso.23627

Cited by 78 publications

(60 citation statements)

References 18 publications

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“…2, 22, 23 Additionally, insurance status seems to greatly impact survival outcomes. While this is not the focus of this study, similar findings have been shown in other cancer types 24, 25 and warrant further investigation as an important disparity in health care delivery and outcomes.…”

Section: Discussionsupporting

confidence: 69%

Use of Radioiodine after Thyroid Lobectomy in Patients with Differentiated Thyroid Cancer: Does It Change Outcomes?

Kiernan

Parikh

Parks

et al. 2015

Journal of the American College of Surgeons

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Background Radioiodine (RAI) lobe ablation in lieu of completion thyroidectomy is not recommended. This study describes RAI utilization patterns and outcomes in patients with well-differentiated thyroid cancer (DTC) after thyroid lobectomy (TL). Methods A total of 170,330 patients diagnosed with DTC between 1998 and 2011 were identified using the National Cancer Database. Demographic, tumor and treatment variables were analyzed using both univariate and multivariate regression. Results A total of 32,119 (20%) patients underwent TL as the definitive procedure. Mean age at diagnosis was 48 years; median tumor size was 1cm, 4% had extrathyroidal extension, 4% had positive lymph nodes and <1% distant metastases. RAI was administered to 24% of patients in the TL cohort and represented 10% of the overall RAI use. In multivariate analysis, RAI use was associated with age<45 (OR 1.51), community facilities (OR 1.26), >1cm tumors (OR 5.67), Stage II or III (OR 1.54 and 2.05), positive lymph nodes (OR 1.78) and extrathyroidal extension (OR 1.36). On both univariate and multivariate analysis, RAI after TL was associated with improved survival at both 5 and 10 years follow up (97% vs. 95% and 91% vs. 89% respectively, HR 0.53, CI: 0.38–0.72, p<0.001) Conclusions Nearly a quarter of TL patients received RAI. The strongest predictors of RAI utilization were larger cancers and advanced stage. The use of RAI in these patients was associated with improved overall survival. Future studies and guidelines will need to more clearly address this practice and educate providers about the appropriate use of RAI in TL patients.

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Section: Discussionsupporting

confidence: 69%

Use of Radioiodine after Thyroid Lobectomy in Patients with Differentiated Thyroid Cancer: Does It Change Outcomes?

Kiernan

Parikh

Parks

et al. 2015

Journal of the American College of Surgeons

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“…Many factors including tumor histology, control of extracranial disease, and PS impact a patient’s overall survival (8). It has been reported that uninsured and underinsured cancer patients often have delayed diagnosis and inferior outcomes (9–11). Our institutional series is unique in that a larger percentage of our patient population is African-American, on Medicaid or on Medicare compared to previous publications reporting health disparities in patients treated for brain metastases (10, 11).…”

Section: Introductionmentioning

confidence: 99%

A Single-Institution Analysis of 126 Patients Treated with Stereotactic Radiosurgery for Brain Metastases

et al. 2017

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BackgroundThe objective of this study was to report our institutional experience with Gamma Knife® Radiosurgery (GKRS) in the treatment of patients with brain metastases.MethodsRetrospectively collected demographic and clinical data on 126 patients with intracranial metastases were reviewed. The patients in our study underwent GKRS at Vidant Medical Center between 2009 and 2014. Kaplan–Meier curves were used to compare survival based on clinical characteristics for univariate analysis, and a Cox proportional hazards model was used for multivariate analysis.ResultsThe median age of the patient population was 62 years. Medicare patients constituted 51% of our patient cohort and Medicaid patients 15%. The most common tumor histologies were non-small cell lung cancer (50%), breast cancer (12.7%), and melanoma (11.9%). The median overall survival time for all patients was 5.8 months. Patients with breast cancer had the longest median survival time of 9.15 months, while patients with melanoma had the shortest median survival time of 2.86 months. On univariate analysis, the following factors were predictors for improved overall survival, ECOG score 0 or 1 vs. 2 or greater (17.0 vs. 1.8 months, p < 0.001), controlled extracranial disease vs. progressive extracranial disease (17.4 vs. 4.6 months, p = 0.0001), recursive partitioning analysis Stage I vs. II–III (18.2 vs. 6.2 months, p < 0.007), multiple GKRS treatments (p = 0.002), prior brain metastasectomy (p = 0.012), and prior chemotherapy (p = 0.021). Age, ethnicity, gender, previous external beam radiation therapy, number of brain metastases, and hemorrhagic vs. non-hemorrhagic tumors were not predictors of longer median survival time. Number of metastatic brain lesions of 1–3 vs. ≥4 (p = 0.051) and insurance status of Medicare/Medicaid vs. commercial insurance approached significance (13.7 vs. 6.8 months, p = 0.08). On multivariate analysis, ECOG performance status 0–1 (p < 0.001), multiple GKRS treatments (p = 0.003), and control of extracranial disease (p = 0.001) remained significant predictors of survival.ConclusionECOG score, control of extracranial disease, and multiple GKRS treatments are predictors of longer median survival following GKRS in our patient population. GKRS is an effective treatment for brain metastases, but these factors may be considered in patient selection for GKRS.

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“…In 2014, Walker et al used the Surveillance, Epidemiology and End Results (SEER) database to evaluate nearly half a million patients diagnosed with one of the ten most common causes of cancer mortality [ [9]. While increased rates of distant or advanced-staged disease among uninsured and Medicaid-insured patients may contribute to lower rates of cancer-directed treatment, socioeconomic factors including an inability to cover out-of-pocket treatment expenses and limited access to care must also be considered.…”

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confidence: 99%

A Brighter Future? The Impact of Insurance and Socioeconomic Status on Cancer Outcomes in the USA: A Review

et al. 2016

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Uninsured and Medicaid-insured cancer patients have been shown to present with more advanced disease, less often receive cancer-directed therapy and suffer higher rates of mortality than those with private insurance. The Patient Protection and Affordable Care Act was signed into law in March of 2010 and seeks to increase rates of public and private health insurance. Although several provisions will in particular benefit those with chronic and high-cost medical conditions such as cancer, the extent to which disparities in cancer care will be eliminated is uncertain. Further legislative changes may be needed to ensure equal and adequate cancer care for all patients regardless of insurance or socioeconomic status.

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The effect of health insurance status on the treatment and outcomes of patients with colorectal cancer

Cited by 78 publications

References 18 publications

Use of Radioiodine after Thyroid Lobectomy in Patients with Differentiated Thyroid Cancer: Does It Change Outcomes?

Use of Radioiodine after Thyroid Lobectomy in Patients with Differentiated Thyroid Cancer: Does It Change Outcomes?

A Single-Institution Analysis of 126 Patients Treated with Stereotactic Radiosurgery for Brain Metastases

A Brighter Future? The Impact of Insurance and Socioeconomic Status on Cancer Outcomes in the USA: A Review

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