Cancer diagnoses and survival rise as 65-year-olds become Medicare eligible.

Abstract

2015 Background: A “Medicare effect” has been described to account for increased health care utilization occurring at the age of 65, when individuals become eligible for government-sponsored health care. The existence of such an effect in cancer care, where it would be most likely to reduce mortality, has been unclear. Methods: Patients aged 61-69 diagnosed with lung, breast, colon, or prostate cancer from 2004-2016 were identified using the Surveillance, Epidemiology, and End Results database and dichotomized based on eligibility for Medicare (age 61-64 vs 65-69). Using age-over-age percent change calculations, trends in cancer diagnosis, AJCC staging, and survival were characterized. Results: 134,991 patients were identified with lung cancer; 175,558 with breast; 62,721 with colon; and 238,823 with prostate. The age-over-age growth in the number of cancer diagnoses was highest at age 65 when compared to all other ages within the decade, for all four cancers (Table: p<0.01, p<0.001, p<0.01, p<0.001 respectively). Comparing age 65 diagnoses to the 61-64 year old cohort, the greatest difference for all four cancers was seen in stage I (lung p<0.001; breast p<0.002; colon p<0.001; prostate p<0.02). The older (65-69), Medicare-eligible cohort had higher cancer specific 5-year survival than the 61-64 aged cohort for lung (22.0% vs 21.0%, p<0.01) and colon cancer (66.2% vs 63.2%, p<0.01). Conclusions: The 65 age threshold for Medicare eligibility is associated with more cancer diagnoses, particularly in stage I, resulting in improved cancer-specific survival for some cancers. Near-elderly individuals may be delaying care until the age of 65. A Medicare-for-all system would thus be likely to reduce cancer mortality. [Table: see text]