Insurance status linked to survival outcomes in metastatic renal cell carcinoma
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NASHVILLE, Tenn. — Insurance status appeared associated with survival among patients with metastatic renal cell carcinoma, according to findings presented at International Kidney Cancer Symposium: North America.
Patients with primary Medicaid or no insurance, as well as those with private insurance, achieved shorter PFS and OS than patients with Medicare.
Patients with secondary insurance achieved longer PFS than those with primary insurance alone.
“Insurance status recently has been identified as a contributing factor to survival among patients with renal cell carcinoma. We wanted to examine how different types of insurance would influence both overall and progression-free survival,” researcher Teebro Paul, a high school junior from Brentwood, Tennessee, who collaborated on the study with investigators from City of Hope, told Healio.
Paul and colleagues retrospectively evaluated the effect of insurance status on PFS and OS among patients who received first-line systemic therapy for metastatic renal cell carcinoma at City of Hope or Huntsman Cancer Institute at The University of Utah.
Researchers identified 645 eligible patients with accessible insurance information and stratified them by insurance type.
More than half (53.3%) had Medicare (median age, 65 years; range, 30-94; 71.2% men; 88.7% white; 16% Hispanic). More than one-third (38.7%) had private insurance (median age, 55 years; range, 22-82; 76.8% men; 90% white; 12% Hispanic). The remaining 7.9% had Medicaid or no insurance (median age, 52 years; range, 25-78; 66.7% men; 78.4% white; 37.3% Hispanic).
The groups appeared balanced with regard to histology and systemic treatment received.
Results showed longer median PFS among patients with Medicare (7.7 months; 95% CI, 7-9) than those with private insurance (5.5 months; 4-7) or Medicaid/no insurance (4.9 months; 95% CI, 3.8-8.1) They also showed significantly longer median PFS among patients with secondary insurance (8.1 months; 95% CI, 6.6-11.3) than those without it (6.1 months; 95% CI, 5.5-7.4; P for comparison = .015).
The OS analysis revealed similar outcomes, with longer median OS observed among those with Medicare (49 months; 95% CI, 41.8-55.3) than private insurance (28.5 months; 95% CI, 24.1-35.7) or Medicaid/no insurance (21.6 months; 95% CI, 17.5-42.3). Researchers also observed longer median OS among those with secondary insurance (40.2 months; 95% CI, 31.4-51) than those without it (36.2 months; 95% CI, 30-44.3), though the difference did not reach statistical significance.
“I thought it was very interesting that Medicare was associated with the best outcomes, particularly compared with private insurance,” Paul said. “More work is needed to determine the reasons for this. However, it is important for oncologists to keep this information in the back of their minds. In addition, it’s also important to look at other issues — like access to care — that some patients with private insurance may be facing.”
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Paul T, et al. Abstract 43. Presented at: IKCS: North America; Nov. 9-11, 2023; Nashville, Tenn.
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