Abstract
Background: Management of advanced-stage non-small cell lung cancer (NSCLC) has changed significantly over the past two decades with the development of numerous systemic treatments, including targeted therapies. However, a high proportion of advanced-stage patients are untreated. The role that health insurance plays in receipt of systemic treatments is unclear. Methods: Using California Cancer Registry data (2012- 2014), we developed multivariable Poisson regression models to assess the independent effect of health insurance type on systemic treatment utilization among patients with stage IV NSCLC. Systemic treatment information was manually abstracted from treatment text fields. Results: A total of 17,310 patients were evaluated. Patients with Medicaid/other public insurance were significantly less likely to receive any systemic treatments [risk ratio (RR), 0.78; 95% confidence interval (CI), 0.75-0.82], bevacizumab combinations (RR, 0.57; 95% CI, 0.45-0.71), or tyrosine kinase inhibitors (RR, 0.70; 95% CI, 0.60-0.82) compared with the privately insured. Patients with Medicare or dual Medicare- Medicaid insurance were not significantly different from the privately insured in their likelihood of receiving systemic treatments. Conclusions: Substantial disparities in the use of systemic treatments for stage IV NSCLC exist by source of health insurance in California. Patients with Medicaid/other public insurance were significantly less likely to receive systemic treatments compared with their privately insured counterparts. Impact: Source of health insurance influences care received. Further research is warranted to better understand barriers to treatment that patients with Medicaid face.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1059-1066 |
| Number of pages | 8 |
| Journal | Cancer Epidemiology Biomarkers and Prevention |
| Volume | 28 |
| Issue number | 6 |
| DOIs | |
| State | Published - Jun 1 2019 |
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ASJC Scopus subject areas
- Epidemiology
- Oncology
Cite this
Disparities in systemic treatment use in advanced-stage non-small cell lung cancer by source of health insurance. / Maguire, Frances B.; Morris, Cyllene R.; Parikh-Patel, Arti; Cress, Rosemary D; Keegan, Theresa H; Li, Chin Shang; Lin, Patrick S.; Kizer, Kenneth W.
In: Cancer Epidemiology Biomarkers and Prevention, Vol. 28, No. 6, 01.06.2019, p. 1059-1066.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Disparities in systemic treatment use in advanced-stage non-small cell lung cancer by source of health insurance
AU - Maguire, Frances B.
AU - Morris, Cyllene R.
AU - Parikh-Patel, Arti
AU - Cress, Rosemary D
AU - Keegan, Theresa H
AU - Li, Chin Shang
AU - Lin, Patrick S.
AU - Kizer, Kenneth W
PY - 2019/6/1
Y1 - 2019/6/1
N2 - Background: Management of advanced-stage non-small cell lung cancer (NSCLC) has changed significantly over the past two decades with the development of numerous systemic treatments, including targeted therapies. However, a high proportion of advanced-stage patients are untreated. The role that health insurance plays in receipt of systemic treatments is unclear. Methods: Using California Cancer Registry data (2012- 2014), we developed multivariable Poisson regression models to assess the independent effect of health insurance type on systemic treatment utilization among patients with stage IV NSCLC. Systemic treatment information was manually abstracted from treatment text fields. Results: A total of 17,310 patients were evaluated. Patients with Medicaid/other public insurance were significantly less likely to receive any systemic treatments [risk ratio (RR), 0.78; 95% confidence interval (CI), 0.75-0.82], bevacizumab combinations (RR, 0.57; 95% CI, 0.45-0.71), or tyrosine kinase inhibitors (RR, 0.70; 95% CI, 0.60-0.82) compared with the privately insured. Patients with Medicare or dual Medicare- Medicaid insurance were not significantly different from the privately insured in their likelihood of receiving systemic treatments. Conclusions: Substantial disparities in the use of systemic treatments for stage IV NSCLC exist by source of health insurance in California. Patients with Medicaid/other public insurance were significantly less likely to receive systemic treatments compared with their privately insured counterparts. Impact: Source of health insurance influences care received. Further research is warranted to better understand barriers to treatment that patients with Medicaid face.
AB - Background: Management of advanced-stage non-small cell lung cancer (NSCLC) has changed significantly over the past two decades with the development of numerous systemic treatments, including targeted therapies. However, a high proportion of advanced-stage patients are untreated. The role that health insurance plays in receipt of systemic treatments is unclear. Methods: Using California Cancer Registry data (2012- 2014), we developed multivariable Poisson regression models to assess the independent effect of health insurance type on systemic treatment utilization among patients with stage IV NSCLC. Systemic treatment information was manually abstracted from treatment text fields. Results: A total of 17,310 patients were evaluated. Patients with Medicaid/other public insurance were significantly less likely to receive any systemic treatments [risk ratio (RR), 0.78; 95% confidence interval (CI), 0.75-0.82], bevacizumab combinations (RR, 0.57; 95% CI, 0.45-0.71), or tyrosine kinase inhibitors (RR, 0.70; 95% CI, 0.60-0.82) compared with the privately insured. Patients with Medicare or dual Medicare- Medicaid insurance were not significantly different from the privately insured in their likelihood of receiving systemic treatments. Conclusions: Substantial disparities in the use of systemic treatments for stage IV NSCLC exist by source of health insurance in California. Patients with Medicaid/other public insurance were significantly less likely to receive systemic treatments compared with their privately insured counterparts. Impact: Source of health insurance influences care received. Further research is warranted to better understand barriers to treatment that patients with Medicaid face.
UR - http://www.scopus.com/inward/record.url?scp=85067176383&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85067176383&partnerID=8YFLogxK
U2 - 10.1158/1055-9965.EPI-18-0823
DO - 10.1158/1055-9965.EPI-18-0823
M3 - Article
C2 - 30842132
AN - SCOPUS:85067176383
VL - 28
SP - 1059
EP - 1066
JO - Cancer Epidemiology Biomarkers and Prevention
JF - Cancer Epidemiology Biomarkers and Prevention
SN - 1055-9965
IS - 6
ER -