Timely Cancer Diagnosis Linked to Insurance Status

MONDAY Feb. 18, 2008 -- People who either have no health insurance or rely on Medicaid are more likely to be diagnosed with advanced cancers than people who have private health insurance, researchers from the American Cancer Society report.

At a time when more than 47 million Americans have no health insurance, the new study clearly shows the effect health insurance has on the timely diagnosis of cancer.

This finding follows an earlier study from the American Cancer Society that showed uninsured patients with cancer were 60 percent more likely to die than insured cancer patients.

"Having financial barriers to health care, based on insurance status, is having a significant impact on our efforts to reduce the toll of cancer," said Elizabeth Ward, director of surveillance research in the department of epidemiology and surveillance research at the American Cancer Society.

"We could make considerable progress in reducing cancer mortality if we could ensure that financial barriers, such as lack of health insurance, did not prevent people from getting recommended cancer screening and access to health care when they have symptoms," Ward added.

The report is published in the March issue of The Lancet Oncology.

In the study, Ward's team used the National Cancer Database, which includes data from 1,430 medical facilities and information on 73 percent of cancer patients in the United States. The current study looked at patients aged 18 to 99 who were diagnosed with any of 12 cancers between 1998 and 2004.

There was a consistent relationship between insurance coverage and the stage at which cancer was diagnosed. Uninsured patients were significantly more likely to be diagnosed with advanced cancers compared with patients who were privately insured, the researchers found.

The two cancers that were most likely to be diagnosed in advanced stages among the uninsured were colorectal cancer and breast cancer.

In addition, Medicaid patients also had an increased risk of being diagnosed with advanced cancer, Ward's group found.

For both Medicaid patients and uninsured patients, cancers that are routinely screened for were the most likely to be diagnosed in an advanced stage. This was also true for cancers that present with symptoms in the earliest stages, such as melanoma and bladder cancer.

Cancers such as pancreatic and ovarian cancer tended to be diagnosed in later stages, regardless of whether the patient was insured, uninsured or on Medicaid. These cancers are typically found in an advanced stage since there are no screening tests that could find them early, Ward noted.

In addition, blacks were more likely to be diagnosed with advanced cancers. This finding shows that barriers to screening tests and health care beyond insurance negatively affect black patients, the researchers suggest.

The American Cancer Society thinks that the health-care system in the United States needs to be reformed, Ward said. "There needs to be a process of really looking at the problems with the way the health insurance system is working. There needs to be a dialogue about how to make this better," she said.

One expert thinks the solution to the health-care insurance problem is universal health insurance.

"We know that the uninsured are 25 percent more likely to die than other Americans," said Dr. Steffie Woolhandler, an associate professor of medicine at Harvard Medical School, and co-founder of Physicians for a National Health Program. "This study tells us one reason why. Many uninsured cancer victims don't get the screening and primary care that would find their disease early, when a cure is still possible," she said.

"The U.S. health system costs twice as much as those of other developed nations, but still leaves millions facing cancer and other serious illness without adequate care," Woolhandler said. "A fundamental change is needed, namely, nonprofit national health insurance."

In another study in the same journal issue, Dutch researchers from the University Medical Centre Groningen recommended that family doctors be involved in the long-term care of children who have survived cancer.

As these cancer survivors age, issues related to their cancer should be integrated with more general medical care by family doctors. This is likely to be more cost-effective than specialist care alone, the researchers reported.

"Loss of long-term cancer survivors to follow-up should be avoided, because many of the potentially serious late effects might not manifest until decades after completion of treatment," the team concluded.

More information

For more on cancer screening, visit the American Cancer Society.

Posted: February 2008


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