Uninsured cancer patients 60-64 face worse outcomes than Medicare beneficiaries aged 66-69

MUSC Hollings Cancer Center lung cancer researcher Gerard Silvestri, MD, found that lack of insurance leads to worse cancer survival than for people on Medicare, in a paper published in the May issue of Health Affairs. This work, a collaborative effort by Silvestri and researchers at the American Cancer Society, highlights the current serious barrier in medical care: Many people cannot take advantage of the newer potentially life-saving treatments because of the high cost.

Silvestri said the research began last year, inspired by the hotly debated topic of extending Medicare insurance coverage to people under 65. Using the National Cancer Database, which included data collected from more than With 1.2 million cancer patients, Silvestri began researching lung cancer outcomes based on insurance status and age.

The lung cancer findings were so surprising that the American Cancer Society recommended looking at 1-year, 2-year, and 5-year survival rates for the 16 most common cancers, including lung, breast, colon, and prostate cancers. Due to the large study population, comorbidity and other disease factors in these four groups could be compared: uninsured patients 60 to 64 years old, private insurance patients 60 to 64 years old, Medicare patients 66 to 69 years old and Medicare plus private insurance 66 to 69 years old .

Overall, when comparing cancer survival in patients with similar stages and types of cancer, younger patients have better outcomes than their older counterparts, Silvestri said. However, this study found that in all 16 cancers, those under Medicare age (60 to 64 years old) without health insurance had significantly worse survival than their older counterparts.

Furthermore, there was a dose-response gradient between the different insurance groups. Uninsured younger patients had the lowest survival, followed by older Medicare patients without additional private insurance, then older Medicare patients with additional private insurance, with younger privately insured patients having the best Survival. The difference in survival was quite surprising, “he said.

Even in cancers with poor five-year survival across all insurance groups, the observed differences between uninsured individuals 60 to 64 years old versus individuals 66 to 69 years old could be seen at one and two years, with Medicare patients having significantly better survival. in those annual milestones compared to younger uninsured patients, ”explains Silvestri, a lung cancer pulmonologist from MUSC Health at Hollings.

Silvestri said this research is important to him given his personal experiences. As one of seven children in his family, Silvestri still vividly remembers how his family dealt with his father’s cancer as he struggled through treatments for more than five years. After his father’s death, the financial burden did not end as his mother continued to pay the medical bills monthly for many years afterward, despite his family having medical insurance.

Unexpected medical expenses are one of the leading causes of personal bankruptcy. Research published in a 2018 article in the American Journal of Public Health found that more than 66% of personal bankruptcy is due to medical debt.

Due to the financial hurdle, uninsured patients often present with advanced, non-curable disease because they can delay medical care or afford screenings. In addition, some cancer drugs cost tens of thousands of dollars annually, which can be more than double a household’s annual income, he said.

“The results of this study prompted me to ask this simple question: ‘Is it okay for a patient to die of cancer simply because he or she does not have health insurance?’ If the answer is ‘no’ to that question, then there needs to be a real policy discussion at a high level, ”said Silvestri.

As a lung specialist, Silvestri is particularly interested in the differences in insurance and survival in lung cancer. Lung cancer is unique in that it mainly occurs in smokers. According to the Centers for Disease Control and Prevention (CDC), about 30% of uninsured adults smoke, and smoking is more common in people with a low annual household income. Since many smokers belong to a segment of the population that does not have insurance, it may affect their ability to pursue care, as many uninsured individuals will not seek regular lung cancer screening, he said.

“Fortunately, the cancer center is really well positioned to help smokers with programmatic support,” said Silvestri. Hollings, the state’s only National Cancer Institute-designated cancer center, has a robust smoking cessation program, a lung cancer screening program, and rigorous inequality research, leading to the implementation of new programs statewide, said he. .

While the current study focused on insurance inequalities and cancer survival outcomes, it is very likely that these findings can be replicated in studies of other chronic diseases, such as diabetes and heart disease. Silvestri hopes this research will be a catalyst for talks about the financial toxicity of cancer treatment, at the state and national levels.

“While I was initially surprised to see that lack of insurance was a greater predictor of worse outcomes in lung cancer than in old age, I was even more shocked to see that this phenomenon was true in all major cancers. and sharing the countless stories of patients who, after being told they have cancer and their world is turned upside down, are forced to ask, “How am I going to afford this?” instead of “What can we do to heal me?” ‘said Silvestri.


Funding: The American Cancer Society database is funded by the public.

About MUSC

Founded in 1824 in Charleston, MUSC is the oldest medical school in the South and the state’s only integrated academic health sciences center with a unique mission to serve the state through education, research, and patient care. Each year, MUSC trains more than 3,000 students and nearly 800 residents in six colleges: dental medicine, graduate studies, health professions, medicine, nursing and pharmacy. The state’s leader in raising funding for biomedical research, in fiscal 2019, MUSC hit a new high, raising more than $ 284 million. Visit musc.edu for information on academic programs.

As the Medical University of South Carolina clinical health system, MUSC Health is committed to providing the highest quality patient care available, while educating generations of skilled, compassionate caregivers to serve the people of South Carolina and beyond. With approximately 1,600 beds, more than 100 outreach locations, the MUSC College of Medicine, the physicians’ practice plan and nearly 275 telecare locations, MUSC Health owns and operates eight hospitals in Charleston, Chester, Florence, Lancaster and Marion counties. In 2020, US News & World Report named MUSC Health the No. 1 hospital in South Carolina for the sixth consecutive year. For more information on clinical patient services, visit muschealth.org.

MUSC and its subsidiaries have a combined annual budget of $ 3.2 billion. More than 17,000 MUSC team members include world-class educators, physicians, specialist suppliers and scientists who provide cutting-edge education, research, technology and patient care

About MUSC Hollings Cancer Center

MUSC Hollings Cancer Center is a National Cancer Institute-designated cancer center and the largest academic cancer research program in South Carolina. The cancer center includes more than 100 faculty cancer scientists and 20 academic departments. It has an annual research funding portfolio of more than $ 44 million and is committed to reducing the cancer burden in South Carolina. Hollings offers state-of-the-art diagnostic capabilities, therapies and surgical techniques within multidisciplinary clinics including surgeons, medical oncologists, radiation therapists, radiologists, pathologists, psychologists and other specialists equipped for the full range of cancer care, including more than 200 clinical taste. Visit hollingscancercenter.musc.edu for more information.

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