A new report from the American Cancer Society finds substantial evidence that lack of adequate health insurance coverage is associated with less access to care and poorer outcomes for cancer patients. The report finds the uninsured are less likely to receive recommended cancer screening tests, are more likely to be diagnosed with later stage disease, and have lower survival rates than those with private insurance for several cancers.
The new findings on stage at diagnosis and survival by insurance status use data from the National Cancer Database (NCDB), a hospital-based registry sponsored by the American College of Surgeons and the American Cancer Society, the only national registry that collects information on patient insurance status.
In 2007, the American Cancer Society launched a nationwide campaign to highlight the role of access to quality care for all Americans. While advances in the prevention, early detection, and treatment of cancer have resulted in an almost 14 percent drop in the death rates from all cancers combined from 1991 to 2004 in the U.S., with remarkable declines in mortality for the top three causes of cancer death in men (lung, colorectal, and prostate cancer) and two of the top three cancers in women, (breast and colorectal cancer), not all segments of the population have benefited equally from this progress.
Evidence suggests that some of these differences are related to lack of access to health care. In particular, the lack of health insurance, or inadequate health insurance, appears to be a critical barrier to receipt of appropriate health care services. The report provides an overview of systems of health insurance in the United States and presents data on the association between health insurance status and screening, stage at diagnosis, and survival for breast and colorectal cancer based on analyses of the National Health Interview Survey (NHIS) and the NCDB. Among the report's findings:
For breast cancer, the article reports that:
For colorectal cancer, the report found that:
Other findings from the study:
"As our nation's investments in cancer research provide greater understanding of how to prevent cancer, detect it early, and treat it effectively, access to health care becomes even more important to the American Cancer Society's goal of eliminating cancer as a major public health problem," said Otis Brawley, M.D., chief medical officer of the American Cancer Society. "This report clearly suggests that insurance and cost-related barriers to care are critical to address if we want to ensure that all Americans are able to share in the progress we have achieved by having access to high-quality cancer prevention, early detection, and treatment services."
"These findings put insurance status squarely on the table as an important factor in cancer care disparities," said Elizabeth Ward, Ph.D., director of surveillance research and co-author of the report. "It's important to note that although variations in health insurance coverage likely contribute to racial and ethnic disparities in cancer outcomes, those disparities persist for several outcomes even when differences in insurance status are accounted for. So even if health insurance and financial barriers can be overcome, further research and interventions will be needed to address these other barriers."
"The truth is that there are gaping holes in our health care safety net and that most of these safety-net services are neither effective nor efficient in providing chronic-disease prevention, detection, or treatment," writes Elmer Huerta, M.D., American Cancer Society president, in an accompanying editorial. "The truth is that our national reluctance to face these facts is condemning thousands of people to die from cancer each year and thousands more to die of other diseases," adding that "[f]or too many hardworking 'average Americans,' paying for cancer treatment means not paying rent, mortgage (resulting in foreclosure or eviction), or utility bills, or even going hungry."
The report appears in the January/February issue of CA: A Cancer Journal for Clinicians, a peer-reviewed journal of the American Cancer Society.
Article: "Association on Insurance with Cancer Care Utilization and Outcomes," , E Ward, M Halpern, N Schrag, V Cokkinides, C DeSantis, P Bandi, R Siegel, A Stewart, A Jemal, CA Cancer J Clin 2008;58:9-31, DOI: 10.3322/CA.2007.0011
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