番茄社区

MIAMI – Patients with private insurance status were more likely to receive treatment for metastatic renal cell carcinoma (mRCC), and had better survival in the targeted therapy era, researchers said here.

Patients age <65 who had private health insurance had a 48% chance of survival for 1 year after their diagnosis versus 39% survival chance for those with no insurance or those on Medicaid, said Yu-Wei Chen, MD, of the Cleveland Clinic, and colleagues.

The adjusted hazard ratio was 1.25 (P<0.0001), they stated in a poster at the International Kidney Cancer Symposium.

Chen told 番茄社区 that the difference in outcome was attenuated when the researchers calculated the difference among people ages ≥65, but having private insurance still made a significant different. In this older population, having private insurance gave an mRCC patient a 35% chance of 1-year survival compared with a 31% 1-year survival for those with government-based or no insurance (P=0.005), he said.

"The gap is more significant for patients under age 65. The key message here is that you need private insurance or better government insurance to live longer if you have metastatic renal cell carcinoma," he noted.

Chen's group analyzed the National Cancer Database, and identified 23,808 mRCC patients (12,189 age <65 and 11,610 age ≥65). About 63% of the patients age <65 had private insurance, while 14% had Medicaid, 11% had Medicare, and 11% were uninsured. In the ≥65 group, 13% had private insurance, 1.9% were on Medicaid, 84% were covered by Medicare, and 0.9% were uninsured.

The researchers adjusted their outcomes for age, race, sex, Charlson comorbidity score, tumor stage, nodal status, cancer histology type, Fuhrman grade, year of diagnosis, and zip code-level socioeconomic data.

They analyzed outcomes of patients diagnosed from 2006 to 2013 in the so-called targeted-agent treatment era. They reported that the odds of receiving a targeted therapy was reduced by 38% if the patient had no health insurance, by 19% if the patient was eligible for Medicaid, by 21% if the patient was on Medicare, and by 41% if the patient was on some other government-supported healthcare plan (P<0.0001 for all).

Chen reported that the patients were also less likely to undergo standard-of-care cytoreductive nephrectomy (P<0.0001 for all):

• No health insurance: 46% less likely to have the surgery
• Medicaid: 39% less likely
• Medicare: 23% less likely
• Other government coverage: 57% less likely

"Not having private insurance meant that the risk of mortality was significantly higher for all the categories," he added, specifically 1-year mortality risk was 22% greater if a patient had no insurance, 23% higher with Medicaid, 19% higher with Medicare, and 20% higher with governmental insurance programs (P<0.0001).

Laura Wood, RN, a research oncology nurse at the Cleveland Clinic told 番茄社区 that getting treatment approvals for patients in government programs is a constant struggle. Wood was not involved in the study.

"These finding make total sense. We spend much of our time fighting to get insurance coverage for patients," she noted. "I think it is a well know fact that it takes longer to get drugs for patients who are underinsured or not insured. That means that even if they have access to the treatment, there is a delay in the initiation of treatment."

"From the nursing perspective, these patients healthcare is also compromised by delays in getting treatment for symptom management as well. That's another whole area that needs to be explored," she added. "There is also a question of duration of therapy and of treatment dose. Those patients who are underinsured don't have readily available access to healthcare for side effect management or disease symptom management that allow people to stay on the appropriate dose or on therapy at all."