Abstract C43: Health changes in low-income men transitioning from prostate cancer coverage to comprehensive insurance
Authors: Kuang Ruby , Nabhani Jamal , Liu Hui , Kwan Lorna , Litwin Mark S. 
Published: February 2019

Abstract
Introduction: The Improving Access, Counseling and Treatment for Californians with Prostate Cancer (IMPACT) program was established in 2001 to provide free prostate cancer treatment and care navigation services for uninsured, low-income men in California. Prior work has highlighted the value of IMPACT's services on improving care coordination and mental well-being of enrolled men, as well as facilitating self-efficacy. The shift from IMPACT to comprehensive health insurance under the Patient Protection and Affordable Care Act (ACA) presented an opportunity to study the effects of the transition from a high-touch, disease-focused program to less-individualized but broader coverage. We hypothesized that health-related quality of life (QOL) would decline in men transitioning from IMPACT to comprehensive insurance relative to a group of men who remained in IMPACT.
Methods: Concurrent with IMPACT enrollment, men were invited to participate in a longitudinal study of general and prostate cancer-related QOL. Using this data, we compared QOL between men who transitioned from IMPACT to full-scope insurance (n=24, intervention) and those who remained in IMPACT (n=39, control). We used the RAND 12-item short form health survey (SF-12 v2) and UCLA Prostate Cancer Index (PCI) to measure general and prostate cancer-related QOL, respectively. The SF-12 v2 includes a mental composite score, a physical composite score, and a measure of general health, each normalized to the general population. The PCI quantifies function and bother related to urinary, sexual, and bowel habits. Data were collected at baseline (6-16 months before exiting IMPACT), transition (4 months before, to 1 month after exit), and post-transition (10-13 months after exit). Mixed-effects models, controlling for type of and time from definitive treatment (surgery or radiation within 12 months), were used to compare measures between the two groups.
Results: Mental, physical, and general health did not differ between the control and intervention groups at baseline. Men who left IMPACT had significantly worse physical health compared to controls at the post-transition time point (p=0.0049). In the mixed-effects model, physical health differed significantly between groups (p=0.0071). Mental health did not. Between the transition and post-transition time points, general health improved significantly in men who left IMPACT (p=0.024), though we found no difference between groups.
Prostate cancer-related QOL did not differ over time between the control and intervention groups. Active treatment within one year from the time of data collection was associated with worse sexual bother (p=0.02); otherwise, there were no differences in prostate cancer-related QOL related to receipt of active treatment within one year from time of data collection.
Conclusion: Disadvantaged men leaving a prostate-cancer treatment and navigation program for comprehensive insurance under the ACA reported worse physical health after the transition, relative to men staying in the program. Mental well-being and prostate cancer-specific QOL tracked similarly between the groups. Further investigation of the mechanisms underlying the decline in physical health after transitioning from IMPACT to full-scope insurance may provide policy makers with actionable information for newly insured vulnerable populations.
Citation Format: Ruby Kuang, Jamal Nabhani, Hui Liu, Lorna Kwan, Mark S. Litwin. Health changes in low-income men transitioning from prostate cancer coverage to comprehensive insurance [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C43.