Uninsured cancer patients are nearly twice as likely to die within five years as those with private coverage, according to the first study of its kind and one that sheds light on troubling health care obstacles.
People without health insurance are less likely to get recommended for cancer screening tests, the study also found, confirming earlier research. And when these patients finally do get diagnosed, their cancer is likely to have spread, The Columbian reported on Friday.
The new research is being published in CA - a cancer journal for clinicians, a cancer society publication. In an accompanying editorial, the society's president repeated the organisation's call for action to fix holes in the health care safety net.
'The truth is that our reluctance to face these facts is condemning thousands of people to die from cancer each year,' Dr Elmer Huerta wrote.
Hard numbers linking insurance status and cancer deaths are scarce, in part because death certificates don't say whether those who died were insured.
An Associated Press estimate based on hospital cancer deaths in 2005 gathered by the US Agency for Healthcare Research and Quality information and other data suggest that at least 20,000 of the nation's 560,000 annual cancer deaths are uninsured when they die.
That's around 4 per cent of the total cancer death toll. One reason is that most fatal cancers occur in people 65 or older - an age group covered by the federal medicare programme. Another is that more than 80 per cent of adults under 65 have some form of coverage, including private insurance or the Medicaid programme for the poor, according to various estimates.
'Insurance makes a big difference in how early you are detecting disease,' said Ken Thorpe, an Emory University health policy researcher.
In the new study, researchers analysed information from 1,500 US hospitals that provide cancer care. They focussed on nearly 600,000 adults under age 65 who first appeared in the database in 1999 and 2000 and who had either no insurance, private insurance or Medicaid.
Researchers then checked records for those patients for the five years following. They found those uninsured were 1.6 times more likely to die in five years than those with private insurance.
More specifically, 35 per cent of uninsured patients had died at the end of five years, compared with 23 per cent of privately insured patients.
Earlier studies have also shown differences in cancer survival rates of the uninsured and insured, but they were limited to specific cancers and certain geographic areas.
The new findings are consistent across different racial groups.
Experts said the study also hints at problems with quality of care after diagnosis, such as whether the patient got the appropriate operation from a high-quality surgeon, whether the tumor was thoroughly evaluated by a high-quality pathologist, and whether there was access to needed chemotherapy and radiation.
'The differences that we see in outcomes after people are diagnosed, even among those with early stage disease, suggest that problems with quality of care may be an important reason,' said Dr John Ayanian, professor of medicine and health care policy at Harvard Medical School.
The study makes an even stronger statement about the role insurance plays in the timing of screenings and how that can raise the likelihood of a late-stage diagnosis, experts said.
A Kaiser Family Foundation survey last year of 930 households that dealt with cancer found that more than one in four uninsured patients delayed treatment or decided not to get it because of the cost.
