title: Population-Level Differences in Rectal Cancer Survival in Uninsured Patients Are Partially Explained by Differences in Treatment.
abstract: Rectal cancer (RC) is a common malignancy with a substantial mortality but good survival for patients with optimally treated nonmetastatic disease. Lack of insurance may compromise access to care and therefore compromise survival. Here, we examine RC survival by insurance type.
  
  
  
  Data from the Surveillance, Epidemiology, and End Results database were used to determine 1- to 3-year survival for patients with RC by insurance type (Medicaid, uninsured, other insurance).
  
  
  
  Patients with Medicaid or no insurance presented at later stages and were less likely to receive definitive surgery. Overall 3-year survival was higher for patients with other insurance compared with Medicaid-insured (+22.2% units) and uninsured (+18.8% units) patients. Major differences in survival were still observed after adjustment for stage. When patients with stage II and III RC were considered, 3-year survival was higher for patients with other insurance versus those with Medicaid (+16.2% units) and uninsured patients (+12.2% units). However, when the analysis was limited to patients with stage II and III disease who received radiation therapy followed by definitive surgery, the difference decreased to +11.8% units and +7.3% units, respectively, for Medicaid and no insurance.
  
  
  
  For patients with stage II and III RC, much of the difference in survival between uninsured patients and those with insurance other than Medicaid can be explained by differences in treatment. Further efforts to determine the cause of residual differences as well as efforts to improve access to standard-of-care treatment for uninsured patients may improve population-level survival for RC.The Oncologist2017;22:351-358 IMPLICATIONS FOR PRACTICE: Insurance status affects survival for patients with rectal cancer, but a substantial proportion of the difference in survival can be corrected if standard-of-care treatment is given. Every effort should be made to ensure that uninsured or publically insured patients receive standard-of-care treatment with as little delay as possible to improve patient outcomes.
authors.affiliation: Division of Clinical Epidemiology and Aging Research pultedi@gmail.com.|Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors.forename: Dianne
authors.initials: D
authors.lastname: Pulte
authors.affiliation: Division of Clinical Epidemiology and Aging Research.
authors.forename: Lina
authors.initials: L
authors.lastname: Jansen
authors.affiliation: Division of Clinical Epidemiology and Aging Research.|Division of Preventive Oncology, and.|German Cancer Consortium (DKTK), German Cancer Research Center, Heidelberg, Germany.|National Center for Tumor Diseases, Heidelberg, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Brenner
mesh_terms: D000073116:Cancer Survivors; D054625:Healthcare Disparities; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D008484:Medicaid; D009367:Neoplasm Staging; D012004:Rectal Neoplasms / Q000453:epidemiology* / Q000628:therapy; D014481:United States
keywords: Disparities; Insurance; Rectal cancer; Survival