title: Insurance status and the use of guideline therapy in the treatment of selected cancers.
abstract: OBJECTIVE
  This study estimates the impact of type of insurance coverage on the receipt of guideline therapy in a population-based sample of cancer patients treated in the community.
  
  
  METHODS
  Patients (n = 7,134) from the National Cancer Institute's Patterns of Care studies who were newly diagnosed with 11 different types of cancer were analyzed. The definition of guideline therapy was based on the National Comprehensive Cancer Network treatment recommendations. Insurance status was categorized as a mutually exclusive hierarchical variable (no insurance, any private insurance, any Medicaid, Medicare only, and all other). Multivariate analyses were used to examine the association between insurance and receipt of guideline therapy.
  
  
  RESULTS
  Adjusting for clinical and nonclinical variables, insurance status was a modest, although statistically significant, determinant of receipt of guideline therapy, with 65% of the privately insured patients receiving recommended therapy compared with 60% of patients with Medicaid. Seventy percent of the uninsured patients received guideline therapy, which was nonsignificantly different compared with private insurance. When stratified by race, insurance was a statistically significant predictor of the receipt of guideline therapy only for non-Hispanic blacks.
  
  
  CONCLUSIONS
  Overall, levels of guideline treatment were lower than expected and particularly low for patients with Medicaid or Medicare only. The use of guideline therapy for ovarian and cervical cancer patients and for patients with rectal cancers was unrelated to type of insurance. Of particular concern is the significantly lower use of guideline therapy for non-Hispanic black patients with Medicaid. After adjusting for other factors, only half of these patients received guideline therapy.
authors.affiliation: Division of Cancer Control and Population Sciences, Cancer Therapy Evaluation Program, National Cancer Institute, National Institute of Health, Bethesda, MD 20892-7344, USA. lh50w@nih.gov
authors.forename: Linda C
authors.initials: LC
authors.lastname: Harlan
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Greene
authors.forename: Limin X
authors.initials: LX
authors.lastname: Clegg
authors.forename: Margaret
authors.initials: M
authors.lastname: Mooney
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Stevens
authors.forename: Martin L
authors.initials: ML
authors.lastname: Brown
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D017057:Medically Uninsured; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics* / Q000628:therapy*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018426:SEER Program / Q000706:statistics & numerical data; D014481:United States