Insurance impacts survival for children, adolescents, and young adults with bone and soft tissue sarcomas

Cancer Medicine

Stephen C. Shiboski¹  Rosanna Wustrack²  Neela L. Penumarthy³  Robert E. Goldsby⁴  Patricia Murphy⁴  Lena E. Winestone⁵ 

[1] Department of Epidemiology and Biostatistics UCSF San Francisco CA USA;Department of Orthopaedic Surgery UCSF San Francisco CA USA;Division of Bioethics and Palliative Care Department of Pediatrics University of Washington School of Medicine Seattle Children's Hospital Seattle WA USA;Division of Oncology Department of Pediatrics UCSF Benioff Children’s Hospital San Francisco CA USA;Helen Diller Family Comprehensive Cancer Center UCSF San Francisco CA USA;

关键词: AYA;    cancer disparities;    health insurance;    pediatrics;    sarcoma;   

DOI  :  10.1002/cam4.2739

来源: DOAJ

【 摘 要 】

Abstract Background While racial/ethnic survival disparities have been described in pediatric oncology, the impact of income has not been extensively explored. We analyzed how public insurance influences 5‐year overall survival (OS) in young patients with sarcomas. Methods The University of California San Francisco Cancer Registry was used to identify patients aged 0‐39 diagnosed with bone or soft tissue sarcomas between 2000 and 2015. Low‐income patients were defined as those with no insurance or Medicaid, a means‐tested form of public insurance. Survival curves were computed using the Kaplan‐Meier method and compared using log‐rank tests and Cox models. Causal mediation was used to assess whether the association between public insurance and mortality is mediated by metastatic disease. Results Of 1106 patients, 39% patients were classified as low‐income. Low‐income patients were more likely to be racial/ethnic minorities and to present with metastatic disease (OR 1.96, 95% CI 1.35‐2.86). Low‐income patients had significantly worse OS (61% vs 71%). Age at diagnosis and extent of disease at diagnosis were also independent predictors of OS. When stratified by extent of disease, low‐income patients consistently had significantly worse OS (localized: 78% vs 84%, regional: 64% vs 73%, metastatic: 23% vs 30%, respectively). Mediation analysis indicated that metastatic disease at diagnosis mediated 15% of the effect of public insurance on OS. Conclusions Low‐income patients with bone and soft tissue sarcomas had decreased OS regardless of disease stage at presentation. The mechanism by which insurance status impacts survival requires additional investigation, but may be through reduced access to care.

【 授权许可】

Unknown