Nav: Home

Evaluating the benefits of health insurance on cancer care

January 27, 2017

Jan, 27, 2017, Lebanon, N.H. -- Millions of Americans acquire their health insurance under the Affordable Care Act, including individuals from disadvantaged communities (as defined by a summary measure comprised of U.S. Census measures of income, education, and employment). Patients with one of the four leading causes of cancer deaths have lower rates of cancer-specific survival based on where they live, specifically based on their social determinants of health. The extent to which health insurance can ease the effects of these social determinants of health on cancer care is the subject of current research led by Dartmouth-Hitchcock Norris Cotton Cancer Center's Sandra Wong, MD, Professor and Chair of Surgery, Senior Vice President of the Surgical Services Line and Interim Vice President of the Oncology Service Line. Her work, "The impact of health insurance status on cancer care in disadvantaged communities" was recently published in the journal, Cancer.

Wong's study finds that the effect of having health insurance appears to be more pronounced in those from disadvantaged communities, compared to more advantaged communities, through better access to cancer care. However, the differences attributed to social determinants of health were not fully mitigated. Insured patients from less disadvantaged communities still had higher odds of receiving cancer-directed surgery and better cancer-specific survival than insured patients from disadvantaged communities. Interestingly, Medicaid insurance was associated with a much more modest survival benefit in those from disadvantaged communities.

"We were seeking to examine the differential impact of health insurance on cancer care across communities with varying social determinants of health" says Wong. "To the best of our knowledge, this is the first national study to explore the interplay between health insurance and social determinants of health and the resultant impact on cancer care and cancer outcomes."

The Dartmouth-Hitchcock study collected Surveillance, Epidemiology, and End Results registry data for 364,507 patients diagnosed with the four highest causes of cancer deaths: breast cancer, prostate cancer, lung cancer, and colorectal cancer, between 2007 and 2011. In the entire cohort, 304,224 patients (83.5%) were insured, 43,572 (12%) had Medicaid coverage, and 16,711 (4.6%) were uninsured. A social determinant score was determined based on five measures of wealth, education, and employment. In order to quantify the differences in the effects of health insurance on these varying social strata, patients were stratified into quintiles, the lowest quintile representing the most disadvantaged communities. Logistic regression and Cox proportional hazards models were used to estimate associations and cancer-specific survival within each quintile. The models were respectively adjusted for age, sex, race/ethnicity, marital status, cancer type, and stage.

Researchers found a consistent relation between a community's relative advantage and cancer-specific care, survival and outcomes. Although health insurance appeared to lessen this relation, it did not fully eliminate the differences caused by the measured social determinants of health. Notably, patients from disadvantaged communities had a larger relative benefit from health insurance, which demonstrated their need for improved access to care.

"These data will help inform ongoing healthcare payment reform efforts," says Wong. "Those from the most disadvantaged communities benefit the most from health insurance, but there are still disparities compared the most advantaged communities. Provisions for insurance are necessary but insufficient to eliminate inequities in cancer outcomes. Attention is also needed for community-level efforts and closer examination of the social determinants of health."
This work was supported by the Agency for Healthcare Research and Quality (T32 HS000053-22), the National Institutes of Health/National Cancer Institute (1K07 CA163665-22), the American Society of Colon and Rectal Surgeons Research Foundation, the Agency for Healthcare Research and Quality (1K08 HS20937-01), and the American Cancer Society (RSG-12-269-01-CPHPS).

About Norris Cotton Cancer Center at Dartmouth-Hitchcock

Norris Cotton Cancer Center combines advanced cancer research at Dartmouth's Geisel School of Medicine with patient-centered cancer care provided at Dartmouth-Hitchcock Medical Center in Lebanon, NH, at Dartmouth-Hitchcock regional locations in Manchester, Nashua and Keene, NH, and St. Johnsbury, VT, and at partner hospitals throughout New Hampshire and Vermont. It is one of 45 centers nationwide to earn the National Cancer Institute's "Comprehensive Cancer Center" designation. Learn more about Norris Cotton Cancer Center research, programs, and clinical trials online at

Dartmouth-Hitchcock Medical Center

Related Prostate Cancer Articles:

Major trial shows breast cancer drug can hit prostate cancer Achilles heel
A drug already licensed for the treatment of breast and ovarian cancers is more effective than targeted hormone therapy at keeping cancer in check in some men with advanced prostate cancer, a major clinical trial reports.
The Lancet: Prostate cancer study finds molecular imaging could transform management of patients with aggressive cancer
Results from a randomised controlled trial involving 300 prostate cancer patients find that a molecular imaging technique is more accurate than conventional medical imaging and recommends the scans be introduced into routine clinical practice.
Common genetic defect in prostate cancer inspires path to new anti-cancer drugs
Researchers found that, in prostate cancer, a mutation leading to the loss of one allele of a tumor suppressor gene known as PPP2R2A is enough to worsen a tumor caused by other mutations.
First prostate cancer therapy to target genes delays cancer progression
For the first time, prostate cancer has been treated based on the genetic makeup of the cancer, resulting in delayed disease progression, delayed time to pain progression, and potentially extending lives in patients with advanced, metastatic prostate cancer, reports a large phase 3 trial.
Men taking medications for enlarged prostate face delays in prostate cancer diagnosis
University of California San Diego School of Medicine researchers report that men treated with medications for benign prostatic hyperplasia (enlarged prostate) experienced a two-year delay in diagnosis of their prostate cancer and were twice as likely to have advanced disease upon diagnosis.
CNIO researchers confirm links between aggressive prostate cancer and hereditary breast cancer
The study has potential implications for families with members suffering from these types of tumours who are at an increased risk of developing cancer.
Distinguishing fatal prostate cancer from 'manageable' cancer now possible
Scientists at the University of York have found a way of distinguishing between fatal prostate cancer and manageable cancer, which could reduce unnecessary surgeries and radiotherapy.
Researchers find prostate cancer drug byproduct can fuel cancer cells
A genetic anomaly in certain men with prostate cancer may impact their response to common drugs used to treat the disease, according to new research at Cleveland Clinic.
ASCO and Cancer Care Ontario update guideline on radiation therapy for prostate cancer
The American Society of Clinical Oncology (ASCO) and Cancer Care Ontario today issued a joint clinical practice guideline update on brachytherapy (internal radiation) for patients with prostate cancer.
Patient prostate tissue used to create unique model of prostate cancer biology
For the first time, researchers have been able to grow, in a lab, both normal and primary cancerous prostate cells from a patient, and then implant a million of the cancer cells into a mouse to track how the tumor progresses.
More Prostate Cancer News and Prostate Cancer Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Making Amends
What makes a true apology? What does it mean to make amends for past mistakes? This hour, TED speakers explore how repairing the wrongs of the past is the first step toward healing for the future. Guests include historian and preservationist Brent Leggs, law professor Martha Minow, librarian Dawn Wacek, and playwright V (formerly Eve Ensler).
Now Playing: Science for the People

#566 Is Your Gut Leaking?
This week we're busting the human gut wide open with Dr. Alessio Fasano from the Center for Celiac Research and Treatment at Massachusetts General Hospital. Join host Anika Hazra for our discussion separating fact from fiction on the controversial topic of leaky gut syndrome. We cover everything from what causes a leaky gut to interpreting the results of a gut microbiome test! Related links: Center for Celiac Research and Treatment website and their YouTube channel
Now Playing: Radiolab

The Flag and the Fury
How do you actually make change in the world? For 126 years, Mississippi has had the Confederate battle flag on their state flag, and they were the last state in the nation where that emblem remained "officially" flying.  A few days ago, that flag came down. A few days before that, it coming down would have seemed impossible. We dive into the story behind this de-flagging: a journey involving a clash of histories, designs, families, and even cheerleading. This show is a collaboration with OSM Audio. Kiese Laymon's memoir Heavy is here. And the Hospitality Flag webpage is here.