Cancer Care Worse with Medicaid, No Insurance

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Those with non-Medicaid insurance more likely to have surgery, radiation, and live longer.
Those with non-Medicaid insurance more likely to have surgery, radiation, and live longer.

Patients with Medicaid insurance or no insurance coverage are less likely to receive cancer-related surgery and/or radiation and are more likely to die from cancer than those with insurance, according to a study published online in the Journal of Clinical Oncology.

Gary V. Walker, M.D., M.P.H., from University of Texas MD Anderson Cancer Center in Houston, and colleagues analyzed data from 473,722 patients (aged 18 to 64 years) who were diagnosed with one of the 10 most deadly cancers in the Surveillance, Epidemiology, and End Results database from 2007 to 2010.

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The researchers found that patients with non-Medicaid insurance were less likely to present with distant disease (16.9 percent) compared to those with Medicaid coverage (29.1 percent) or without insurance coverage (34.7 percent; P < 0.001).

Additionally, patients with non-Medicaid insurance were more likely to receive cancer-directed surgery and/or radiation therapy (79.6 percent) versus those with Medicaid coverage (67.9 percent) or without insurance coverage (62.1 percent; P < 0.001).

Patients were more likely to die as a result of their disease if they had Medicaid coverage (hazard ratio, 1.44; P < 0.001) or no insurance (hazard ratio, 1.47; P < 0.001) compared with non-Medicaid insurance, when adjusting for age, race, sex, marital status, residence, percent of county below federal poverty level, site, stage, and receipt of cancer-directed surgery and/or radiation therapy.

"Among patients with the 10 most deadly cancers, those with Medicaid coverage or without insurance were more likely to present with advanced disease, were less likely to receive cancer-directed surgery and/or radiation therapy, and experienced worse survival," the authors write.

One author disclosed financial ties to the medical device industry.

  1. Walker, Gary V., et al. "Disparities in Stage at Diagnosis, Treatment, and Survival in Nonelderly Adult Patients With Cancer According to Insurance Status." Journal of Clinical Oncology. doi: 10.1200/JCO.2014.55.6258. August 4, 2014.

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