Uninsured and Medicaid Patients More Likely to be Diagnosed With Late-Stage Colorectal Cancer

Roxanne Nelson

January 28, 2008

January 28, 2008 (Orlando, Florida) — Patients without health insurance and those on Medicaid have a significantly higher risk of being diagnosed with advanced-stage colorectal cancer, according to research presented at the 2008 Gastrointestinal Cancers Symposium.

"Colorectal cancer can often be diagnosed early with appropriate screening and attention to relevant symptoms, such as blood in the stool," said study author Michael T. Halperin, MD, PhD, who is strategic director for health services research at the American Cancer Society in Atlanta, Georgia. "It can even be prevented by detecting and removing precancerous lesions at a very early stage."

However, previous studies have shown that uninsured individuals and those covered by Medicaid are less likely to receive screening or have a regular source of medical care than those who are covered by private insurance.

"The issue here is that we have a cancer that is basically preventable, and it is preventable by individuals having colonoscopies and removing premalignant polyps," commented Nicholas Petrelli, MD, medical director of the Helen F. Graham Cancer Center in Newark, Delaware. "We need to develop screening programs for people without insurance and for those who are low income."

Dr. Halperin explained to journalists that the reason for this study was to evaluate the hypothesis that individuals who are less likely to have a regular source of medical care and less likely to receive screenings are also less likely to have their cancer diagnosed at an early stage.

Dr. Halperin and Alexandre L. Pavluck, MPH, also from the American Cancer Society, evaluated the association between colorectal cancer stage at diagnosis and insurance status using the National Cancer Data Base, which is a hospital-based registry jointly sponsored by the American Cancer Society and the American College of Surgeons. Using this database, which captures 75% of all new cancer cases in the United States, they identified 493,419 patients, aged 50 years or older, who had been diagnosed with stage I to IV cancer of the colon, rectum, or rectosigmoid junction between 1998 and 2004.

The cohort was fairly evenly divided by sex and stage at diagnosis. The majority of patients were white (83.6%), and a significant number were insured by Medicare (63.2%). Approximately one third (32.4%) had private insurance, 1.96% were uninsured, and 2.46% were covered by Medicaid.

"We found that patients who were uninsured were about twice as likely to be diagnosed with advanced disease, compared with patients with private insurance," said Dr. Halperin. "Medicaid patients were about 50% more likely to be diagnosed with advanced colorectal cancer than those with private insurance."

The elevated risk for Medicaid and uninsured patients being diagnosed at an advanced stage of disease was seen for cancers in all anatomic areas of the colon, the rectosigmoid junction, and rectum. However, the researchers found that Medicare patients were just as likely to be diagnosed at an early stage as individuals with private insurance.

The authors also looked at other factors that might influence diagnosis at an advanced stage, and found that patients who were black or Hispanic were more likely to be diagnosed at a later stage of disease. Women were more likely than men to be diagnosed with advanced colorectal cancer, and older individuals were also more likely to be diagnosed at a later stage.

Patients who received their treatment at a community hospital, as opposed to a teaching or research facility, were also more likely to be diagnosed at a later stage of colorectal cancer. Although the researchers were not able to look at individual socioeconomic status, they did find that, as a group, residence in zip codes with lower household-income and lower education levels put individuals at risk for diagnosis at an advanced stage.

"In summary, we have found that uninsured and Medicaid patients have a significantly elevated risk of being diagnosed with advanced-stage colorectal cancer, and this was seen consistently through different regions of the colon, as well as the rectosigmoid junction and rectum," he said. "It is our belief that improved screening and access to other medical care among these underserved populations may be able to reduce this substantial disparity."

Dr. Halperin added that there is a need to set up a healthcare system where individuals who are uninsured or underinsured have access to cancer screening, as well as to appropriate diagnostic technology and treatment. "There needs to be some changes in the healthcare system to allow these underserved groups to get these services as they are needed and where they are needed," he said.

But part of the problem, Dr. Petrelli pointed out, is that many patients without insurance lack a medical home, and it is one of the biggest barriers to appropriate care. "It is important to get them into a primary practice and a medical home so that they can get into the loop of cancer screening" he said.

2008 Gastrointestinal Cancers Symposium (GCS): Abstract 275. Presented January 26, 2008.

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