The effect of health insurance status on the treatment and outcomes of patients with colorectal cancer
Article first published online: 8 MAY 2014
© 2014 Wiley Periodicals, Inc.
Journal of Surgical Oncology
Volume 110, Issue 3, pages 227–232, September 1, 2014
How to Cite
Parikh, A. A., Robinson, J., Zaydfudim, V. M., Penson, D. and Whiteside, M. A. (2014), The effect of health insurance status on the treatment and outcomes of patients with colorectal cancer. J. Surg. Oncol., 110: 227–232. doi: 10.1002/jso.23627
- Issue published online: 1 AUG 2014
- Article first published online: 8 MAY 2014
- Manuscript Accepted: 21 MAR 2014
- Manuscript Received: 9 DEC 2013
- colorectal cancer;
- health insurance;
- adjuvant chemotherapy;
Background and Objectives
Uninsured and underinsured cancer patients often have delayed diagnosis and inferior outcomes. As healthcare reform proceeds in the US, this disparity may gain increasing importance. Our objective was to investigate the impact of health insurance status on the presentation, treatment, and survival among colorectal cancer (CRC) patients.
A total of 10,692 patients diagnosed with CRC between 2004 and 2008 identified from the Tennessee Cancer Registry were stratified into five groups: Private, Medicare, Military, Medicaid, and uninsured. Multivariable regression models were constructed to test the association of insurance with receipt of recommended adjuvant therapy and overall survival (OS).
Uninsured and Medicaid patients were more often African American (AA) and presented with higher stage tumors (P < 0.001). Medicare patients were less likely to receive recommended adjuvant therapy (OR 0.54). Lack of insurance, Medicaid, and failure to receive recommended adjuvant therapy were independently associated with worse OS.
Although uninsured and Medicaid patients receive recommended adjuvant therapy comparable to other patients, they present with later stage disease and have a worse OS. Future studies are needed to better explain these disparities especially in the light of changing healthcare climate in the US. J. Surg. Oncol. 2014 110:227–232. © 2014 Wiley Periodicals, Inc.