Medicare eligibility at 65 years of age is associated with an increase in early-stage cancer diagnoses and a resulting survival benefit, according to a study published in Cancer.

The study authors identified patients aged 60 to 69 years from the Surveillance, Epidemiology, and End Results (SEER) program who were diagnosed from 2004 to 2016 with lung, colon, breast, or prostate cancer. The patients were dichotomized regarding their eligibility for Medicare: those aged 61 to 64 years (pre-Medicare group) and those aged 65 to 69 years (post-Medicare group). The investigators conducted a matched analysis comparing the 2 groups to assess cancer stage differences, survival times, 5-year cancer-specific mortality, and rates of cancer-specific surgery.

A total of 134,991 patients with lung cancer, 175,558 with breast cancer, 62,721 with colon cancer, and 238,823 with prostate cancer were included. The increase in age-over-age—trends in cancer diagnoses made within a specific age year—for the number of cancer diagnoses was higher among participants transitioning from age 64 to age 65 years compared with all other age transitions. This finding was observed for patients with lung (P <.01), breast (P <.001), colon (P <.01), and prostate cancer (P <.001). In the years following age 65, the proportional change was negative for all 4 cancers.


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The largest increase in cancer diagnosis at age 65 years was in stage I for all 4 cancer types. The increase in stage I diagnoses at age 65 years compared with that for ages 61 to 64 years had a higher level of statistical significance compared with the increase in diagnoses at higher stages for lung cancer (P <.001), breast cancer (P =.001), and colon cancer (P <.001).

After matching for key demographics between the 2 groups, the study authors again observed a stage shift showing higher proportions of patients with stage I cancers compared with stage IV cancers in the post-Medicare group for all 4 tumor types.

The 5-year cancer-specific mortality for the pre-Medicare group was poorer for patients with lung cancer (86.3% vs 78.5%; P <.001), breast cancer (32.7% vs 11.0%; P <.001), colon cancer (57.1% vs 35.6%; P <.001), and prostate cancer (16.9% vs 4.8%; P <.001), compared with those in the post-Medicare group.

The researchers also found that a larger proportion of patients in the post-Medicare group had surgery for cancer compared with those in the pre-Medicare group (lung cancer, 25.3% vs 11.0%, P <.001; breast cancer, 93.9% vs 75.4%, P <.001; colon cancer, 90.1% vs 77.9%, P <.001; and prostate cancer, 45.2% vs 35.9%, P <.001, respectively).

A limitation of the findings is that the SEER data set did not allow the study authors to identify patients who elected Medicare Part B coverage, which is voluntary and requires a monthly premium. The authors noted that the outpatient care covered by Part B is a likely driver for the increased cancer diagnoses observed at age 65 years. Also, the investigators were unable to identify Medicare beneficiaries who were uninsured before age 65 years.

The study results provided support “…for the hypothesis that patients are delaying cancer-related diagnostic and therapeutic interventions until they become Medicare-eligible,” according to the researchers. “This delay may result in unnecessary cancer deaths,” the study authors concluded.

Disclosures: One of the study authors declared an affiliation with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Patel DC, He H, Berry MF, et al. Cancer diagnoses and survival rise as 65-year-olds become Medicare-eligible. Cancer. Published online March 29, 2021. doi:10.1002/cncr.33498