Insurance Status Affected Glioblastoma Survival

Patients with glioblastoma and germ cell tumors who were uninsured or who had Medicaid at the time of diagnosis were more likely to be diagnosed with a larger tumor and had shorter survival times in the case of glioblastoma compared with people who were insured through Medicare or private insurance, according to the results of a pair of studies published in Cancer.

In the first study, researchers looked at data from the SEER program on 13,665 adult patients with glioblastoma diagnosed between 2007 and 2012.

“To the best of our knowledge, the current study represents the first in the current literature to associate insurance status with survival among patients with glioblastoma,” wrote researchers led by Judy Huang, MD, of the Johns Hopkins University School of Medicine in Baltimore, Maryland. “Medicaid insurance and uninsured status were both independent predictive factors of shorter survival in patients with glioblastoma after adjusting for age, sex, race, marital status, tumor size, and treatment modalities.”

The researchers noted that the effect of the Patient Protection and Affordable Care Act on survival is still undergoing investigation.

Huang and colleagues used an accelerated failure time model to conduct a survival analysis between insurance status and glioblastoma-related death. Of the patients included, 4.1% were uninsured, 11.1% had Medicaid, and 84.8% had non-Medicaid insurance. The median overall survival of the patients was 10.1 years.

The analysis showed that those patients with insurance were more likely to be older, women, white, married, and have smaller tumor size at diagnosis. Using the accelerated failure time analysis, the researchers found several independent risk factors for shorter survival, including older age (hazard ratio [HR], 1.04; P < .001), male sex (HR, 1.08; P < .001), large tumor size at diagnosis (HR, 1.26; P < .001), being uninsured (HR, 1.14; P = .018), and having Medicaid (HR, 1.10; P = .006).

In contrast, the researchers found better survival outcomes were associated with radiotherapy (HR, 0.40; P < .001) and married status (HR, 0.86; P < .001).

“It is interesting to note that considerable variability in insurance may exist within the Medicaid or non-Medicaid category, including flexibility of coverage (health maintenance organization vs preferred provider organization) and level of insurance,” the researchers wrote. “Although the specific type of insurance was not included in the SEER data set, the difference in survival time between uninsured patients and those with non-Medicaid insurance in the current study indicated a differentiation effect of socioeconomic status on the survival status of patients with glioblastoma on a more general scale.”

Huang and colleagues also looked at the trend of survival during 5 consecutive years and found that there was an improvement in survival across all of the insurance groups from 2007 to 2011. However, when they stratified the results by insurance status, it revealed that the trend did not occur in patients with Medicaid or those who were uninsured.

The second study looked at insurance status among more than 10,000 men diagnosed with testicular cancer between 2007 and 2011. The study showed that those patients that were uninsured or on Medicaid had a greater risk of having a larger testicular tumor or metastatic disease when diagnosed. In addition, they were more likely to die from their disease compared with men with insurance.

In an editorial accompanying these studies, Michael Halpern, MD, of Temple University in Philadelphia, and Otis Brawley, MD, of the American Cancer Society and Emory University in Atlanta, wrote that “while much of today’s research focuses on basic understanding of cancer and the development of new treatments, diagnostics, and molecular markers, studies such as these are important if we are to truly address the cancer problem.” They added that “adequate healthcare 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.”