Insurance Status is an Independent Predictor of Overall Survival in Patients With Stage III Non-small-cell Lung Cancer Treated With Curative Intent

Our work demonstrates that insurance status is an independent predictor of overall survival in patients with stage III non small-cell lung cancer undergoing definitive treatment. This work highlights the importance of improved access to affordable healthcare, and how lack of access has significant mortality consequences in lung cancer. Introduction: Population studies suggest an impact of insurance status on oncologic outcomes. We sought to explore this in a large single-institution cohort of patients with non-small-cell lung cancer (NSCLC). Materials and Methods: We retrospectively analyzed 342 consecutive patients (January 2000 to December 2013) curatively treated for stage III NSCLC. Patients were categorized by insurance status as uninsured (U), Medicare/Medicaid + Veterans Affairs (M/M + VA), or Private (P). The chi(2) test was utilized to compare categorical variables. The Kaplan-Meier approach and the Cox proportional hazard models were used to analyze overall survival (OS) and freedom from recurrence (FFR). Results: Compared with M/M + VA patients, P insurance patients were more likely to be younger ( P < .001), married ( P < .001), Caucasian ( P = .001), reside in higher median income zip codes ( P < .001), have higher performance status ( P < .001), and undergo consolidation chemotherapy ( P < .001) and trimodality therapy ( P < .001). Diagnosis to treatment was delayed > 30 days in U (67.3%), M/M + VA (68.1%), and P (52.6%) patients ( P = .017). Compared with the M/M + VA and U cohorts, P insurance patients had improved OS (median/5-year: 30.7 months/34.2%, 19 months/17%, and 16.9 months/3.8%; P < .001) and FFR (median/5-year: 18.4 months/27.3%, 15.2 months/23.2%, and 11.4 months/4.8%; P = .012), respectively. On multivariate analysis, insurance status was an independent predictor for OS ( P = .017) but not FFR. Conclusion: Compared with U or M/M + VA patients, P insurance patients with stage III NSCLC were more likely to be optimally diagnosed and treated, resulting in a doubling of median OS for P versus U patients. Improved access to affordable health insurance is critical to combat inequities in access to care and has potential for improvements in cancer outcomes. (C) 2019 Elsevier Inc. All rights reserved.