The authors utilized the National Cancer Database (NCDB) to identify 43,578 patients presenting with metastatic prostate cancer from 2004-2014, defined as M1 disease at initial evaluation. Univariate and multivariate logistic regression models were utilized to assess factors associated with receipt of treatment, defined as hormonal or chemotherapy, in men with private insurance, no insurance, Medicare, or Medicaid. The Kaplan-Meier method was used to assess the timing of care from diagnosis and compared with the log-rank test. Factors independently associated with timing of therapy were evaluated using Cox multivariate regression analysis.
There were 62% of patients who had Medicare, 25% private insurance, 7% Medicaid, and 6% no insurance. Men with private insurance received therapy at the highest rate (82.4%) compared to Medicaid (80%), no insurance (78%), and Medicare (75.8%) (p < 0.05). After adjusting for age, race, income, education level, Charlson Comorbidity Index, and PSA at presentation, the only covariate associated with no receipt of therapy was lack of insurance (adjusted OR 0.77, 95%CI 0.69-0.85). The median time to receipt of treatment was 38 days in patients with Medicaid, 35 days with no insurance, 32 days with Medicare, and 31 days with private insurance (log-rank p-value 0.63). On Cox multivariate regression analysis, there was no statistically significant delay in treatment for patient with Medicaid or no insurance. Medicare coverage was independently associated with a shorter time from diagnosis to treatment (adjusted OR 1.04, 95% CI 1.01-1.07).
In summary, men without health insurance are significantly less likely to receive treatment for metastatic prostate cancer at initial diagnosis. However, for men receiving care, timeliness of therapy appears adequate and similar between insurance statuses. Barriers to care in the uninsured and underinsured remain even after a diagnosis of metastatic prostate cancer and remains an important opportunity to improve care delivery.
1. Weiner AB, Matulewicz RS, Tosoian JJ, et al. The effect of socioeconomic status, race, and insurance type on newly diagnosed metastatic prostate cancer in the United States (2004-2013). Urol Onc 2017 Nov 15 [Epub ahead of print].
Presented by: Jared Schober, MD
Co-Authors: Kristian Stensland MD MPH, Harras Zaid MD, Alireza Moinzadeh MD and David Canes MD
Affiliation: Lahey Hospital and Medical Center, Burlington MA
Written by: Zachary Klaassen, MD, Society of Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre @zklaassen_md at the 18th Annual Meeting of the Society of Urologic Oncology, November 20-December 1, 2017 – Washington, DC