Abstract 6470: Real-world analysis of insurance status and survival in patients with selected GI cancers
Authors: AbuAyed Rebecca , Schwanke Joshua , Patterson Brooke , White McKenzie , Marmor Schelomo , Jensen Eric , Tignanelli Christopher , Lou Emil , Prakash Ajay 
Published: March 2024

Background: Health insurance is a critical determinant of healthcare access and outcomes in gastrointestinal (GI) cancers. Epidemiological data have shown that insurance-associated healthcare outcomes vary by diagnosis, geographic location, and demographics. Thus, it is critical for cancer providers to understand local impacts of insurance status on patient outcomes. Here, we present real-world outcomes for pancreatic, hepatobiliary, and colorectal cancer (CRC) patients in 11 Midwest hospitals based on insurance status.

Methods: We identified patients diagnosed with colorectal, pancreatic, and hepatobiliary cancers within 11 Midwest hospitals from 2011-2021 with North American Association of Central Cancer Registries data. Health insurance was defined as private, Medicaid, Medicare, and uninsured. Effect of insurance status at diagnosis on overall survival (OS) in selected cancers combined and by cancer type were calculated using a Cox proportional hazard (CoxPH) model controlling for age, sex, race, stage, time to treatment initiation (TTI), and Charlson Comorbidity Index (CCI). We evaluated differences in TTI by insurance status using t-tests. We analyzed stage and treatment modality by insurance status using chi-square tests. Post-hoc analysis of TTI by OS used CoxPH.

Results: Relative to private insurance, Medicaid and Medicare insurance status significantly reduced OS for all selected GI cancers combined (HR 1.38, 95% CI 1.17 - 1.62 and HR 1.25, 95% CI 1.11 - 1.40, respectively; p&lt;0.001) and for CRC (HR 1.49, 95% CI 1.12 - 1.98 and HR 1.28, 95% CI 1.06 - 1.54, respectively; p&lt;0.01). Uninsured patients had significantly reduced OS only for pancreas cancer (HR 6.36, 95% CI 2.56 - 15.8; p&lt;0.001). No significant associations between insurance status and OS were noted in Hepatobiliary cancer. TTI was significantly associated with insurance status (p&lt;0.001) and mean TTI for Medicaid (35.8 days) and Medicare (27.9 days) patients was longer than mean TTI for privately insured patients (23.3 days; p&lt;0.01). TTI for uninsured patients was not significantly different than for privately insured. Analysis of TTI and OS showed no increased hazard for patients with TTI of 36 days versus 23 days (HR 0.87, 95% CI 0.75 - 1.02; p=0.085). Treatment modality and stage did not differ as a function of insurance status in this dataset.

Discussion: Our results expand previous work by demonstrating a survival impact for GI cancer patients with Medicaid or Medicare insurance. This disparity persists despite controlling for known prognostic factors such as age, stage, CCI, and TTI. Notably, TTI varied by insurance suggesting it may account for a portion of this disparity but did not independently drive survival. Further work is required to identify and develop targeted interventions to address other drivers of reduced survival in those without private insurance.

Citation Format: Rebecca AbuAyed, Joshua Schwanke, Brooke Patterson, McKenzie White, Schelomo Marmor, Eric Jensen, Christopher Tignanelli, Emil Lou, Ajay Prakash. Real-world analysis of insurance status and survival in patients with selected GI cancers [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6470.