In two new studies, U.S. cancer patients who are uninsured or have government-sponsored Medicaid insurance for the poor tend to be diagnosed later, receive less optimal treatment and survive for a shorter time than people with private health insurance.
In one study of testicular germ cell cancer, which usually afflicts young men, 10 percent of patients were uninsured and 13 percent had Medicaid. They were 26 percent and 62 percent, respectively, more likely than men with other insurance to have metastatic disease - cancer that had spread by the time it was diagnosed. They were also less likely to undergo lymph node dissection.
"The thought is, and the data support, that patients are presenting with more advanced disease if they don't have insurance," senior author Christopher Sweeney of the Dana-Farber Cancer Institute in Boston told Reuters Health. "This would suggest that they are delaying their presentation, presumably because they have a fear of seeing a doctor because of the financial implications."
There are almost 9,000 new diagnoses of testicular cancer each year in the U.S., affecting men at an average age of 33, according to the American Cancer Society.
In Sweeney and colleagues' study of more than 10,000 men diagnosed with testicular cancer between 2007 and 2011, uninsured men also had an 88 percent higher risk of death from the disease than those with insurance, according to the results in the journal Cancer.
In the second study, senior author Dr. Judy Huang of the Johns Hopkins University School of Medicine in Baltimore and her colleagues identified almost 13,700 new cases of malignant brain tumors called glioblastoma between 2007 and 2012. Of these patients, 4 percent were uninsured, 11 percent had Medicaid and the rest had other insurance coverage.
Being uninsured or having Medicaid coverage was associated with shorter survival time, as was older age, male sex and larger tumor size.
"We have found that non-Medicaid insured patients have a significant survival benefit over uninsured and even Medicaid insured patients," said Dr. Wuyang Yang, a research fellow at Johns Hopkins Hospital and coauthor of the study.
"Within the context of the current study, we cannot confirm the underlying reason for these associations," Yang told Reuters Health by email. "However, as previous studies that investigated insurance status and survival in other types of cancers have suggested, one of the potential reasons might be the disparity in healthcare access in patients with different insurance types."
In addition, Yang said, the researchers think insurance status is an indirect indicator of the glioblastoma patients' socioeconomic status and having "sufficient socioeconomic support . . . might be critical for the outcomes of these patients."
There were almost 23,000 new cases of brain or nervous system cancer in the U.S. in 2015 and glioblastoma accounts for 17 percent of brain cancers, according to the National Cancer Institute. Glioblastoma tends to occur in adults between ages 45 and 70 years.
It's not clear from these studies if insurance status is also related to outcomes in other diseases, Yang noted.
"The provision of adequate care for all individuals diagnosed with cancer has the potential to save thousands of additional lives per year," Michael T. Halpern of the Temple University College of Public Health in Philadelphia and Otis W. Brawley of the American Cancer Society and Emory University in Atlanta write in an editorial accompanying the two studies.
"The underserved deserve service," Halpern and Brawley write. "Adequate health care should be considered an inalienable human right, and greater emphasis is needed on realizing strategies that will make this happen throughout the continuum of cancer care."
The Affordable Care Act is increasing access to preventive early-action healthcare, so these trends could change in coming years, Sweeney said. "Some benefits are already being seen under the ACA."
For patients, "the issue is, don't avoid evaluating symptoms because of fear of cost," he said. Urgent care centers that see uninsured patients may be a good option, he said.
"For policymakers it's very concerning and should be sorted out," Sweeney said.