Impact of treatment and insurance on socioeconomic disparities on the survival of renal cancer patients in Thailand.

Abstract

576 Background: Access to care is an important aspect of high-quality cancer care. Patients' health insurance status is a factor influencing an individual's ability to access high-quality cancer care. The increased costs of cancer care are negatively impacting patients. 75% of Thai people use the Thailand’s Universal Coverage Scheme (UCS), about 15% use the Civil Servant Medical Benefit Scheme (CSMBS) or the Social Security Scheme (SSS). Only CSMBS can reimburse cost of the targeted therapy. Multiple new therapies have emerged for the treatment of metastatic renal cell carcinoma (mRCC) that showed OS increased in following introduction of targeted therapies and immunotherapy. However, many patients lack access to affordable, high-quality cancer care. Aim: To determine the relationship between treatment affordability, insurance status and RCC cancer survival. Methods: Retrospectively reviewed 281 medical records of RCC patients at the Ramathibodi hospital between January 2009 and December 2017. We searched the Surveillance, Epidemiology, and End Results dataset. Kaplan–Meier methods and multivariable Cox regression models were used to analyze survival outcomes and risk factors. Results: 281 RCC patients, and 127 metastasis were identified. Median age was 59.1 years, and 74.7% were male gender. There were clear cell carcinoma (77.9%), and non-clear cell was 17.1%. IMDC prognostic model categorized as favorable/intermediate/poor risk group as 14.2%/51.2%/29.1%. 41.7% has health insurance status as CSMBS, 7% in SSS and 50.9% in UCS. Only 50% of SSS and UCS paid out of their pocket of mRCC treatment. First line treatment for mRCC were targeted therapy with VEGFR TKI 73.9%, but 26.8% received only supportive care. Median OS was 24 months in the treatment group and only 4.1 months in the best supportive care group (p <0.05). Health insurance status and medication affordability was confirmed as an independent prognostic factor for mRCC patients. Conclusions: Insurance status and medication affordability are important predictive factors for mRCC, and improving access to affordable targeted therapies is likely to improve outcomes in mRCC.