Abstract
Objectives. The study objective was to determine how insurance status relates to treatment receipt and overall survival for patients with early-stage pancreatic exocrine carcinoma. Methods. SEER data were evaluated for 17,234 patients diagnosed with Stage I/II pancreatic exocrine carcinoma. Multivariate regression models controlled for personal characteristics to determine whether insurance status was independently associated with overall survival and receipt of radiation/surgery. Results. Odds of receiving radiation were 1.50 and 1.75 times higher for insured patients compared to Medicaid and uninsured patients, respectively (p < 0.01). Insured patients had 1.68 and 1.57 times increased odds of receiving surgery compared to Medicaid and uninsured patients (p < 0.01). Risk of death was 1.33 times greater (p < 0.01) in Medicaid patients compared to insured patients; when further adjusted for treatment, the risk of death was attenuated but remained significant (HR = 1.16, p < 0.01). Risk of death was 1.16 times higher for uninsured patients compared to insured patients (p = 0.02); when further adjusted for treatment, the risk of death was no longer significant (HR = 1.01, p = 0.83). Conclusions. Uninsured and Medicaid-insured patients experience lower treatment rates compared to patients who have other insurances. The increased likelihood of treatment appears to explain the insured group's survival advantage.
Highlights
Average survival time for pancreatic exocrine carcinoma patients is among the poorest of all cancer types
Most patients were insured by private insurance, Medicare, or other government insurance plans (87.0%, n = 14,997); others were covered by Medicaid (10.8%; n = 1,860) or were uninsured (2.2%; n = 377)
Pancreatic exocrine carcinomas are aggressive and deadly, but proven treatments exist for early-stage disease
Summary
Average survival time for pancreatic exocrine carcinoma patients is among the poorest of all cancer types. There are effective treatments for early-stage disease [3], many patients do not receive them. A minority of patients with early-stage disease undergo pancreatic resection, for example, even though it is a first-line therapy and is associated with improved survival [4,5,6,7,8]. A SEER Patterns of Care study showed that pancreatic cancer patients were more likely to receive cancer-directed surgery if they were insured [11]. Two studies covering separate states have shown that patients with Medicaid or government-subsidized insurance have lower rates of cancer-directed surgery compared to those with private insurance [12, 13]
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