Insurance Status May Predict Cancer Outcome in Young Adults

Ayal A. Aizer, MD, MHS Harvard Radiation Oncology Program Boston, MAMedicalResearch Interview with:
Ayal A. Aizer, MD, MHS
Harvard Radiation Oncology Program
Boston, MA

MedicalResearch: What are the main findings of the study?

Dr. Aizer: We studied Americans between the ages of 20-40 using the SEER Database (a national cancer registry) and found that patients who had insurance were more likely to present with localized (curable) versus metastatic (generally incurable) cancer. Patients with localized tumors were more likely to receive the appropriate treatment and, most importantly, survived longer than patients without insurance. Our analysis accounted for demographic and socioeconomic differences between patients who were insured versus uninsured. Our results indicate that insurance status is a powerful predictor of outcome among young adults with cancer. The Affordable Care Act, which will likely improve insurance coverage nationally, may yield improved cancer outcomes among Americans.


MedicalResearch: Were any of the findings unexpected?

Dr. Aizer: It is not surprising, to us, that patients who were insured were more likely to be diagnosed with cancers of earlier stages than those who were not. What was surprising to us is that if one is to control for the stage that a patient presents at and the treatment that they receive (as well as demographic/socioeconomic variables) that insured patients are more likely to be cured of their cancer than uninsured patients. This suggests that, even if an insured patient and an uninsured patient are diagnosed with the same stage of cancer and receive the same treatment modalities, that the insured patient still displays better survival.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Aizer: Insurance status is a powerful predictor of outcome for patients with cancer. Every effort should be made to improve insurance access nationally, and young adults should be encouraged to sign up for insurance plans (as stipulated in the Affordable Care Act) rather than pay a penalty. One consequence of the Affordable Care Act is that select young males, in particular, may face particularly high premium increases relative to their current rates. It may be difficult for them to purchase the insurance that they need. This is a group that should be further studied after full implementation of the Affordable Care Act.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Aizer: As mentioned above, young males (who may face particularly high premium increases on the individual market after full implementation of the Affordable Care Act), should be evaluated closely in the years to come. Targeted subsidies may be needed for such patients.

Citation:

Cancer-Specific Outcomes Among Young Adults Without Health Insurance
Ayal A. Aizer, Benjamin Falit, Mallika L. Mendu, Ming-Hui Chen, Toni K. Choueiri, Karen E. Hoffman, Jim C. Hu, Neil E. Martin, Quoc-Dien Trinh, Brian M. Alexander, and Paul L. Nguyen

JCO JCO.2013.54.2555; published online on June 2, 2014;