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Private insurance associated with longer survival in metastatic renal cell carcinoma
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MIAMI — An analysis of patients with metastatic renal cell carcinoma treated during the targeted therapy era showed those with private insurance survived significantly longer than those with no insurance or government insurance, according to study results presented at International Kidney Cancer Symposium.
“This survival disparity was more significant [among] patients aged younger than 65 years, suggesting insurance status determined access to metastatic renal cell carcinoma treatment,” Yu-Wei Chen, MD, MS, of Cleveland Clinic Taussig Cancer Institute, and colleagues wrote. “The difference was mitigated by Medicare [among] patients aged 65 years or older.”
Treatment costs for metastatic renal cell carcinoma have increased with the development of targeted therapy, and this may affect access to care, according to study background.
Chen and colleagues assessed the effect of insurance status on receipt of treatment and survival among patients with metastatic renal cell carcinoma.
Researchers used the National Cancer Data Base to identify patients diagnosed with metastatic renal cell carcinoma from 2006 to 2013.
The analysis included 23,808 patients, of whom 12,189 (51%) were aged younger than 65 years and 11,619 (49%) were aged 65 years or older.
The majority of patients aged younger than 65 years had private insurance (63%), whereas 14% had Medicaid, 11% had Medicare and 11% had no insurance.
Most patients aged 65 years or older had Medicare (83%), whereas 13% had private insurance, 1.9% had Medicaid and 0.9% had no insurance.
Multivariable logistic regression showed patients with private insurance were significantly more likely to receive targeted therapy than those with Medicaid (adjusted OR [aOR] = 0.81; 95% CI, 0.74-0.9), Medicare (aOR = 0.79; 95% CI, 0.73-0.86), no insurance (aOR = 0.62; 95% CI, 0.55-0.7) or other government insurance (aOR = 0.59; 95% CI, 0.47-0.74).
Patients with private insurance also were significantly more likely to undergo cytoreductive nephrectomy than those with Medicare (aOR = 0.77; 95% CI, 0.7-0.84), Medicaid (aOR = 0.61; 95% CI, 0.54-0.69), no insurance (aOR = 0.54; 95% CI, 0.47-0.62) or other government insurance (aOR = 0.43; 95% CI, 0.33-0.57).
Multivariable Cox regression showed patients with private insurance had significantly reduced risk for overall mortality compared with those who had Medicaid (adjusted HR [aHR] = 1.23; 95% CI, 1.16-1.31), Medicare (aHR = 1.19; 95% CI, 1.14-1.25), no insurance (aHR = 1.22; 95% CI, 1.13-1.3) or other government insurance (aHR = 1.2; 95% CI, 1.06-1.36).
Among patients aged younger than 65 years, researchers reported a significantly higher rate of propensity score-adjusted 12-month survival for those with private insurance (48% vs. 39%; aHR = 1.25; P < .0001). The difference in 12-month survival rates narrowed among those aged 65 years or older but remained statistically significant (35% vs. 31%; HR = 1.03; P = .005). – by Mark Leiser
For more information:
Chen Y-W, et al. The association between insurance status and survival in metastatic renal cell carcinoma in the United States. Presented at: International Kidney Cancer Symposium; Nov. 3-4, 2017; Miami.
Disclosure: The researchers report no relevant financial disclosures.