Women with breast cancer who were insured with Medicare or Medicaid had lower survival rates than those patients who had private insurance in two large treatment clinical trials, according to a study presented on December 13 at the 2019 San Antonio Breast Cancer Symposium.
Government-insured breast cancer patients were less likely to participate in clinical trials, and those who did stopped treatment early, according to the researchers.
"Patients with government-type insurance appeared to face barriers in trial treatment completion and had a lower survival compared with their privately insured counterparts," wrote the authors, led by Dr. Samilia Obeng-Gyasi, a breast surgical oncologist at Ohio State University.
Studies have shown a link among insurance status, socioeconomic status, and disparities in clinical outcomes in breast cancer patients. Since lawmakers continue to change insurance at the federal and state levels, better understanding the link among these factors could help physicians and policymakers make better decisions and improve clinical outcomes.
The retrospective study was conducted by researchers at the ECOG-ACRIN Cancer Research Group in Philadelphia with funding from the U.S. National Cancer Institute.
The researchers looked at data from 9,800 women with breast cancer who participated in two large ECOG-ACRIN trials testing chemotherapy treatments. Participants were enrolled in a trial from 1999 to 2002, and patients were enrolled in another trial from 2007 to 2011.
Only about 13% of participants in each of the two trials had government insurance. About 86% had private insurance and the rest were self-pay.
The risk of death increased by one-half for those who participated in the first trial and had government insurance. The risk increased by one-third for government-insured women who participated in the second trial, according to the researchers.
In the first trial, 1 out of every 4 government-insured patients did not complete treatment. Approximately 1 out of 2 government-insured patients did not complete therapy, compared with 1 out of 3 privately insured patients, in the second trial.
Most clinical trials do not collect data on social determinants of health, but they should, according to the study authors. Clinicians could have a better understanding of the relationship between insurance status and many other factors that affect the outcomes of clinical trial participants if this information were collected, they noted.
"Future studies are encouraged to focus on patient and institution related variables that might be contributing to these insurance-based disparities in outcomes," the authors wrote.
