A new American Cancer Society study shows that uninsured adolescents and young adults were far more likely to be diagnosed with late-stage cancer, which is more difficult and expensive to treat and more deadly, compared to young patients with health insurance. The study, published early online, will appear in the March issue of the journal CANCER.
The study's authors says their data suggest a way forward for cancer control efforts in the adolescent and young adult (AYA) population, a group that has benefited the least from recent progress in cancer. "The findings suggest that policies such as the Affordable Care Act that increase the number of people in America with health coverage will result in fewer late-stage cancer diagnoses and save lives."
For their study, researchers led by Anthony Robbins, M.D., Ph.D., American Cancer Society director of health services research, analyzed data from nearly 260,000 cancer patients ages 15 to 39 in the National Cancer Database.
After adjusting for age, race/ethnicity, facility type, ZIP code-based income and education levels, and U.S. Census region, it was found that uninsured males were 1.51 times more likely to be diagnosed at a distant stage of disease compared with patients with private insurance. Among females, the effect of insurance was even stronger, with uninsured patients found to be 1.86 times more likely to be diagnosed at a distant stage.
Uninsured patients were younger, more likely to be male, more likely to be black or Hispanic, more likely to reside in the South, more likely to be treated in teaching/research facilities, and less likely to be treated in NCI-designated facilities. Uninsured patients were also more likely to reside in ZIP codes with the lowest median income, as well as in ZIP codes with the highest percentage of residents without a high school diploma.
"We believe that this observation holds the promise of improved cancer control efforts in the AYA population, after decades in which AYA patients have experienced far less victory in the War on Cancer than their younger and older counterparts," conclude the authors. "However, the success of these efforts may be directly tied to the fate of the Medicaid expansion component of the Patient Protection and Affordable Care Act, which, at the time of this writing, remains quite unclear."
- Anthony S. Robbins, Catherine C. Lerro, Ronald D. Barr. Insurance status and distant-stage disease at diagnosis among adolescent and young adult patients with cancer aged 15 to 39 years: National Cancer Data Base, 2004 through 2010. Cancer, 2014; DOI: 10.1002/cncr.28568
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