Health Insurance Coverage Disruptions and Cancer Care and Outcomes: Systematic Review of Published Research

• Type of Material: Article
• Authors: Karen Yabroff, Emory University; K. Robin Reeder-Hayes, University of North Carolina; Jingxuan Zhao, American Cancer Society; Michael T. Halpern, National Cancer Institute; Ana Maria Lopez, Thomas Jefferson University; Leon Bernal-Mizrachi, Emory University; Anderson B. Collier, University of Mississippi; Joan Neuner, Medical College of Wisconsin; Jonathan Phillips, American Society of Clinical Oncology; William Blackstock, Wake Forest University; Manali Patel, Stanford University
• Language: English
• Date: 2020-07-01
• Publisher: Oxford University Press Inc.
• Publication Version: Final Published Version
• Copyright Statement: © 2020 Oxford University Press.
• License: Creative Commons Universal : Public Domain Dedication
• Final Published Version (URL): http://dx.doi.org/10.1093/jnci/djaa048
• Title of Journal or Parent Work: JNCI: Journal of the National Cancer Institute
• Volume: 112
• Issue: 7
• Start Page: 671
• End Page: 687
• Grant/Funding Information: No funding was provided for this research.
• Keywords: Survival; Science & Technology; New York; Oncology; Life Sciences & Biomedicine; Breast-cancer; Preventive care; Treatment patterns; Diagnosis; Access; Low-income countries; Medicaid enrollment; Stage
• Research Categories: Health Sciences, Oncology; Health Sciences, Health Care Management; Health Sciences, Public Health

Abstract

Background Lack of health insurance coverage is associated with poor access and receipt of cancer care and survival in the United States. Disruptions in coverage are common among low-income populations, but little is known about associations of disruptions with cancer care, including prevention, screening, and treatment, as well as outcomes of stage at diagnosis and survival. Methods We conducted a systematic review of studies of health insurance coverage disruptions and cancer care and outcomes published between 1980 and 2019. We used the PubMed, EMBASE, Scopus, and CINAHL databases and identified 29 observational studies. Study characteristics and key findings were abstracted and synthesized qualitatively. Results Studies evaluated associations between coverage disruptions and prevention or screening (31.0%), treatment (13.8%), end-of-life care (10.3%), stage at diagnosis (44.8%), and survival (20.7%). Coverage disruptions ranged from 4.3% to 32.8% of patients age-eligible for breast, cervical, or colorectal cancer screening. Between 22.1% and 59.5% of patients with Medicaid gained coverage only at or after cancer diagnosis. Coverage disruptions were consistently statistically significantly associated with lower receipt of prevention, screening, and treatment. Among patients with cancer, those with Medicaid disruptions were statistically significantly more likely to have advanced stage (odds ratios = 1.2-3.8) and worse survival (hazard ratios = 1.28-2.43) than patients without disruptions. Conclusions Health insurance coverage disruptions are common and adversely associated with receipt of cancer care and survival. Improved data infrastructure and quasi-experimental study designs will be important for evaluating the associations of federal and state policies on coverage disruptions and care and outcomes.