Uninsured More Likely to Die From Cancer FollowingDiagnosis

THURSDAY, Dec. 20 (HealthDay News) -- People diagnosed with cancer whodon't have health insurance are more likely to die because they are lesslikely to get screening tests and so are typically diagnosed with advanceddisease, a new study from the American Cancer Society finds.
The finding proffers strong evidence that differences in cancersurvival are directly related to lack of access to health care.
"If you are uninsured, and you are diagnosed with cancer, you have a 60percent greater chance of dying from cancer than if you were insured anddiagnosed with cancer," said Dr. Otis Brawley, chief medical officer atthe cancer society.
"There is not a cohort of insured and a cohort of uninsured cancerpatients that have the same five-year survival," Brawley added. "It'salways the uninsured who do worse."
Part of the problem is that uninsured people don't have access toscreenings, Brawley said. "But part of it is that uninsured people don'thave access to the best doctors or have access to good doctors who areoverwhelmed. The end result is the quality of care the poor folks get isnot as good as the quality of care of the wealthier or the insured," hesaid.
There are also people who are underinsured, Brawley said. While thesepeople have access to care, high co-pays and deductibles make the careunaffordable, particularly high-priced chemotherapy drugs, he noted.
"Where it becomes frightening and morally reprehensible is people whohave significant pain and can't get narcotics and other pain medicationsthey need, because they can't afford them," Brawley said.
People don't realize they are underinsured until after they have gottensick, Brawley said. "There are a substantial number of Americans who don'trealize they are a cancer diagnosis away from economic disaster," henoted.
The study, in the January/February issue of CA: A Cancer Journal forClinicians, used data from the National Cancer Database, which is theonly national registry that collects data on patient insurance.
The report is an overview of systems of health insurance in the UnitedStates. It has data on the association between health insurance,screening, stage at diagnosis, and survival for breast and colorectalcancer.
The link between access to care and cancer outcomes is particularlystriking for cancers that can be prevented or found early by screening andfor which there are effective treatments, including breast and colorectalcancer.
Only about 38.1 percent of uninsured women aged 40 to 64 have had amammogram in the past two years, compared with 74.5 percent of insuredwomen. In addition, 20 percent to 30 percent of uninsured women arediagnosed with late-stage breast cancer, compared with 10 percent to 15percent of women with private insurance, according to the study.
Uninsured women are less likely to be diagnosed with early breastcancer than women who are privately insured. This disparity was greatestamong white women, where almost 50 percent of those with private insurancewere diagnosed with early-stage cancer, compared with fewer than 35percent of uninsured white women.
Moreover, 89 percent of insured white women were living five yearsafter breast cancer diagnosis compared with 76 percent of uninsured whitewomen. For black women, five-year survival rates are 81 percent for thosewith private insurance and 65 percent for uninsured women.
For men and women aged 50 to 64 who have private insurance, 48.3percent were screened for colorectal cancer in the past 10 years comparedwith fewer than 18.8 percent of the uninsured.
In addition, uninsured patients are more likely than those with privateinsurance to be diagnosed with stage IV colorectal cancer and less likelyto be diagnosed with stage I colorectal cancer, the researchers found.
For whites, 66 percent of insured patients survive colorectal cancerfor five years, compared with 50 percent of those without insurance. Forblacks, five-year survival rates are 41 percent among the uninsuredcompared with 60 percent among privately insured patients.
Additional findings in the study include:
Uninsured women were less likely to have a Pap test in the past threeyears than insured women (68 percent vs. 87.9 percent).Among insured men, 37.1 percent had a prostate specific antigen test,compared with 14 percent of uninsured men.People aged 18 to 24 have the highest probability of beinguninsured.Lower-income people are more likely to be uninsured.Blacks, Hispanics, Asian American/Pacific Islanders, and AmericanIndian/Alaska Natives are more likely to be uninsured than whites.Of those without insurance, 53.6 percent have no usual source ofhealth care.The uninsured are more likely to delay care, not receive care, and notobtain prescription drugs because of costs.Among people who saw a health-care provider, those without insurancewere less likely to be advised to quit smoking or lose weight.Brawley noted that while some of the uninsured qualify for Medicaid,coverage doesn't begin until the cancer has been diagnosed.
"You have someone who is uninsured and poor -- gets none of thescreenings, gets none of the early detection opportunities -- when theyfinally go to the doctor, it's because they are so sick, they can nolonger go to work, or their family is forcing them to go to the emergencyroom," Brawley said. "What you have is someone who a year ago we could,relatively cheaply, fix, maybe even cure, but now that they have ignoredtheir symptoms, it's no longer fixable, we are going to treat them, butthe treatment is going to be very expensive."
The remedy to the problem is "making sure that everyone who wantshealth insurance can get affordable health insurance," Brawley said. "Inthis country, we need to have an open conversation about this issue."
One expert thinks this study highlights the need for a health insuranceprogram that covers everyone.
"Sadly, many Americans must face the challenges of cancer with noinsurance coverage, or with Medicaid, which is often grossly inadequate ascoverage," said Dr. Steffie Woolhandler, an associate professor ofmedicine at Harvard Medical School and a co-founder of Physicians for aNational Health Program.
For these cancer patients, diagnosis is delayed and survival isshortened, Woolhandler said. "We need nonprofit national health insuranceto be sure that everyone gets the health care they need, particularlypeople with cancer."