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Uninsured and Medicaid Patients at Elevated Risk of Advanced CRC: Presented at ASCO-GI

By Charlene Laino

ORLANDO, FL -- January 28, 2008 -- Patients who have no medical insurance or who are covered by Medicaid are significantly more likely to be diagnosed at an advanced stage of colorectal cancer (CRC) than patients who have private insurance or are covered by Medicare, suggests an analysis of data on nearly 500,000 colorectal cancer patients in the United States.

Michael T. Halpern, MD, PhD, Strategic Director of Health Services Research, American Cancer Society, Atlanta, Georgia, reported the findings here on January 26 at the American Society for Clinical Oncology's 2008 Gastrointestinal Cancers Symposium (ASCO-GI).

The symposium is cosponsored by ASCO with the American Gastroenterological Association Institute, the American Society for Therapeutic Radiology and Oncology, and the Society for Surgical Oncology.

Dr. Halpern said that previous studies have shown that patients who are uninsured or are covered by Medicaid are less likely than those with private insurance to receive appropriate colorectal screening or to have a regular source of medical care. "This may affect diagnosis of colorectal cancer at early versus late stages," he said.

The researchers reviewed data from all 493,419 patients aged 50 years or older in the National Cancer Data Base who were diagnosed with stage I to IV cancer of the colon, rectum, or rectosigmoid junction between 1998 and 2004. The hospital-based registry, sponsored by the American Cancer Society and the American College of Surgeons, captures about 75% of all cancer patients in the United States, Dr. Halpern said.

The majority of patients had Medicare (63.2%) or private insurance (32.4%); 2.0% were uninsured and 2.4% were covered by Medicaid. The insurance breakdown is consistent with the overall US population when matched for age, race, and gender, he said.

Results showed that uninsured patients were 90% more likely and Medicaid patients were 40% more likely to be diagnosed with stage II than stage I disease compared with those who had either private insurance or Medicare (difference not significant between the two latter groups).

Similarly, uninsured patients were 2.0 times as likely, and Medicaid patients were 1.5 times more likely to be diagnosed with advanced disease (stage III or IV) than either Medicare or privately insured patients.

"When looked at by anatomic site, we saw consistent convincing evidence that no matter where the cancer was, patients on Medicare or with private insurance [were diagnosed at earlier disease stages]," Dr. Halpern said.

"Improved screening and access to other medical care among these underserved populations may reduce this substantial disparity," he said.

Other factors that were associated with a more advanced stage at diagnosis were being black or Hispanic, being female or older, being treated at a community hospital, and living in a zip code with lower household income and lower education levels, Dr. Halpern added.


[Presentation title: Association Between Insurance Status and Stage at Diagnosis for Patients With Colorectal Cancer. Abstract 275]

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