Follicular lymphoma patients in the U.S. with private insurance are about twice as likely to survive their cancer than those without health insurance or covered by public plans like Medicare or Medicaid, a study reports.
The research, “Disparities in survival by insurance status in follicular lymphoma,” was published in the journal Blood.
Follicular lymphoma is the most common indolent — or slow-growing — lymphoma and the second most common non-Hodgkin lymphoma (NHL), accounting for about 10-20% of all lymphomas in Western countries.
A patient’s insurance status is known to influence the stage at which a cancer is diagnosed and the choice of treatment. NHL patients with private insurance are diagnosed earlier and more likely to receive immunotherapies like Rituxan (rituximab).
The socioeconomic status of people with follicular lymphoma also seems to influence cancer survival, as those living in areas characterized by poorer or disadvantaged conditions have considerably lower survival rates.
Emory University scientists investigated the impact of insurance on the outcomes of follicular lymphoma patients. Using the National Cancer Database, they analyzed records of 43,648 adults diagnosed with follicular lymphoma between 2004 and 2014.
They defined a patient’s insurance status as the “primary payer at the time of diagnosis,” and grouped patients by whether they had private insurance (47%), no insurance (3%), Medicaid (4%), or Medicare (46%).
They also took into consideration patients’ age, race, education level, NHL symptoms, cancer stage at diagnosis, time from diagnosis until treatment, presence of other diseases, and overall survival. The study population was divided into two groups: those under age 65 (22,133 people), and those 65 or older (21,515).
Overall survival at five years among patients younger than 65 was 78% for the uninsured, 80% for those on Medicaid, and 78% for those on Medicare, compared to 90% for those privately insured, the study found. In the same age group, patients with Medicaid, Medicare or no insurance were also more likely to have a delay in treatment and to receive systemic therapy (i.e., chemotherapy or immunotherapy) in comparison to those privately insured. But the researchers also noted that younger patients on Medicare were more likely to have serious comorbidities (unrelated illnesses) than other patients.
Depending on cancer subtype, early treatment does not always improve overall survival. For some patients, close observation (a “watch and wait” tactic) is often recommended.
In this study, those who chose a watchful waiting approach had better outcomes than patients submitted to systemic treatment, “suggesting watchful waiting can be useful for the appropriately selected [follicular lymphoma] patient,” the researchers noted.
Among patients ages 65 and older, only those covered by Medicare had significantly poorer overall survival at five years compared to privately insured patients, or 62% to 69% respectively.
Poorer socioeconomic status, advanced cancer stage, presence of systemic symptoms, and multiple comorbidities were more commonly observed in patients with no health insurance or with Medicaid.
“These associations persisted when controlling for the known and available sociodemographic and prognostic factors,” they wrote.
In both study groups, regardless of cancer stage, private health coverage was a significant predictor of improved overall survival in comparison to no insurance, Medicaid, and Medicare.
“The findings of the study indicate that improving access to affordable, quality healthcare may reduce disparities in survival for those currently lacking coverage,” the researchers concluded.
