Insurance status impacts overall survival in Burkitt lymphoma

• Type of Material: Article
• Authors: Jordan S Goldstein, Emory University; Jeffrey Switchenko, Emory University; Madhusmita Behera, Emory University; Christopher Flowers, Emory University; Jean Koff, Emory University
• Language: English
• Date: 2019-07-05
• Publisher: Taylor & Francis
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: Rights managed by Taylor & Francis
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1080/10428194.2019.1623884
• Title of Journal or Parent Work: LEUKEMIA & LYMPHOMA
• Volume: 60
• Issue: 13
• Start Page: 3552
• End Page: 3234
• Grant/Funding Information: Research reported in this publication was supported in part by the Winship Research Informatics and Biostatistics and Bioinformatics Shared Resources of Winship Cancer Institute of Emory University and NIH/NCI under award number P30CA138292, by number K24CA208132 to Dr. Flowers, and by the National Center for Advancing Translational Sciences of the National Institute of Health under Award Number UL1TR000454. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
• Keywords: non-Hodgkin lymphoma; survival; insurance; Burkitt lymphoma; plasmablastic lymphoma

Abstract

The impact of insurance status on clinical outcomes in Burkitt (BL) and plasmablastic (PBL) lymphomas remains unknown. We used the National Cancer Database to examine insurance status’ effect on overall survival (OS) in adults diagnosed with these lymphomas between 2004 and 2014. BL patients with private insurance had significantly better OS compared to those without. In patients aged <65 years, hazard ratios were 1.4 for uninsured status (95% confidence interval 1.2–1.7), 1.2 for Medicaid (95% CI 1.0–1.4), and 1.5 for Medicare (95% CI 1.2–1.9). For patients aged >65, hazard ratio for uninsured status was 8.4 (95% CI 2.5–28.3). Conversely, underinsured PBL patients experienced no difference in OS. Thus, expanding insurance-related access to care may improve survival in BL, for which curative therapy exists, but not PBL, where more effective therapies are needed. Our findings add to mounting evidence that adequate health insurance is particularly important for patients with curable cancers.