Disparities in Systemic Treatment Use in Advanced-stage Non-Small Cell Lung Cancer by Source of Health Insurance
| Autor: | Patrick S. Lin, Cyllene R. Morris, Theresa H.M. Keegan, Chin-Shang Li, Rosemary D. Cress, Arti Parikh-Patel, Frances B. Maguire, Kenneth W. Kizer |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
0301 basic medicine
Male Lung Neoplasms Epidemiology Medical and Health Sciences Insurance Coverage 0302 clinical medicine Carcinoma Non-Small-Cell Lung Antineoplastic Combined Chemotherapy Protocols Registries Non-Small-Cell Lung Lung Cancer Medically Uninsured Lung Cancer Middle Aged Oncology Health 030220 oncology & carcinogenesis symbols Female medicine.drug medicine.medical_specialty Bevacizumab Medicare 03 medical and health sciences symbols.namesake Insurance Clinical Research Internal medicine medicine Health insurance Humans Poisson regression Healthcare Disparities Lung cancer Aged Neoplasm Staging Insurance Health business.industry Medicaid Carcinoma medicine.disease Confidence interval Drug Utilization United States Cancer registry 030104 developmental biology Relative risk business Follow-Up Studies |
| Zdroj: | Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, vol 28, iss 6 |
| ISSN: | 1538-7755 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|