Health Care Costs and Financing

Cancer survival is lower among Medicaid than non-Medicaid patients, especially for those enrolled after cancer diagnosis

Medicaid-insured patients with breast, colorectal, or lung cancer have lower survival rates than non-Medicaid-insured patients with the same types of cancer. A recent study found that this disparity is even more pronounced for patients who enroll in Medicaid after cancer diagnosis, usually with late-stage disease. The study was supported in part by the Agency for Healthcare Research and Quality (HS14206).

Cancer survival in the Medicaid population cannot be improved as long as 40 percent of the population enrolls in Medicaid after diagnosis with late-stage disease, notes first author Cathy Bradley, Ph.D., of Virginia Commonwealth University. Dr. Bradley, Joseph Gardiner, Ph.D., of Michigan State University, and their colleagues used the Michigan Tumor Registry to compare the survival of patients enrolled in Medicaid—either before or after the month of a breast, colorectal, or lung cancer diagnosis—with the survival of non-Medicaid cancer patients over an 8-year period.

Patients who were enrolled in Medicaid before diagnosis survived twice as long as patients who enrolled after cancer diagnosis (median of 38 vs. 19 months), partly due to the high proportion of lung cancer and other late-stage cancers among those enrolled after diagnosis. Nevertheless, the likelihood of death was two to three times as great for patients enrolled in Medicaid relative to those who were not enrolled in Medicaid, once the analysis was stratified by cancer site and stage.

About 54 percent of the non-Medicaid sample and 40 percent of the Medicaid sample had early-stage cancers (in situ and local cancers combined). Yet, only 27 percent of those who enrolled in Medicaid after diagnosis had early-stage cancers, due in part to the preponderance of lung cancer in this group. Lung cancer is almost always diagnosed at late stages, note the researchers.

See "Cancer, Medicaid enrollment, and survival disparities," by Drs. Bradley and Gardiner, Charles W. Given, Ph.D., and Caralee Roberts, Ph.D., in Cancer 103, pp. 1712-1718, April 2005.

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