A recent study of chronic myeloid leukemia (CML) patient outcomes found a direct and disturbingly high correlation between insurance status at diagnosis and overall survival (OS).1
For patients under 65 years, the authors wrote, those “who were uninsured or had Medicaid insurance had an approximately 2-fold hazard for death in comparison with patients with other insurance.”
Previous studies of other cancers suggest similar links between Medicaid or a lack of insurance with more advanced disease stage at time of diagnosis — and worse outcomes.
One 2014 analysis of 473,722 patients between 18 and 64 in the Surveillance, Epidemiology, and End Results (SEER) database concluded that, “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.”2
The present study, however, specifically looked at CML because it is a “highly treatable” disease with very specific and effective therapies “available to those who can afford them.”
In fact, tyrosine kinase inhibitor (TKI) therapy is so effective that, as an editorial accompanying the study noted, “the lifespan of a CML patient, regardless of his or her decade in life, approximates that of normal (non-CML) individuals.”
That’s true, though, only for those who adhere faithfully to their treatment regimen of daily medication. But, with the average cost of treatment close to or above $146,000 per year, even those with private insurance can find it hard to meet the cost of their copayment.3
A 2013 analysis found that “approximately 17% of patients with higher copayments and 10% with lower copayments discontinued TKIs during the first 180 days following initiation (adjusted risk ratio [aRR], 1.70; 95% CI, 1.30-2.22). Similarly, patients with higher copayments were 42% more likely to be nonadherent.”4
And, according to the present study’s corresponding author, Andrew M. Brunner, MD, of the division of hematology and oncology at Massachusetts General Hospital in Boston, missing as few as 10% of prescribed doses is associated with significantly worse molecular response rates.
“That is just 3 days out of a month,” he added.