About 70,000 young people ages 15 to 39 are diagnosed with cancer each year in the U.S., and cancer is leading cause of death from disease in this age group. While cancer survival continues to improve for children and older adults, outcomes have greatly lagged for teens and young adults.
In recognizing this worrisome disparity, the medical community is working to identify the factors that may be contributing to this population’s inferior survival outcomes. In a study featured today on the cover of Cancer, “Insurance status and risk of cancer mortality among adolescents and young adults,” researchers have identified one of those factors: lack of health insurance and limited access to medical care.
“In knowing that teens and young adults are historically the least insured age group in the country, we set out to determine if limited access to medical care was leading to delays in diagnosis and patients presenting with later stage, less curable disease,” said lead author Dr. Abby Rosenberg, who is the medical leader of Seattle Children’s Adolescent and Young Adult (AYA) Cancer Program and a researcher in Seattle Children’s Research Institute’s Center for Clinical and Translational Research. “What we found was that insurance status is in fact independently associated with advanced-stage cancer and the risk of death from cancer, even for patients who have low-stage disease.”
Having a “medical home” is key
By using the Surveillance, Epidemiology, and End Results (SEER) 18 registries, Rosenberg and her team examined the insurance status and stage of disease of 57,981 patients ages 15 to 39 years that were diagnosed with cancer between 2007 and 2010. For the analysis, Rosenberg and her team grouped Medicaid and no insurance under the category of nonprivate insurance because patients who are uninsured at the time of diagnosis often get Medicaid.
In comparison to patients who had private insurance, those who had nonprivate insurance presented with more advanced-stage cancer and had a higher risk of death. Surprisingly, Rosenberg said the relative risk of death was highest among patients who had a lower stage of cancer at diagnosis, possibly indicating a lack of access to proper follow-up care after treatment.
Patients ages 25 to 39 years who had Medicaid coverage had 3.2 times and those with no insurance had 2.4 times higher odds of presenting with stage IV disease. Among those with stage I/II and III/IV cancers, the risk of death was about 2.9 times greater and 1.7 times greater than the risk for privately insured patients. Patients who died from stage III/IV cancers survived at least two months longer if they had private insurance.
“These findings underscore the important of teens and young adults having a consistent medical home, a place they feel comfortable going to for preventative, routine medical care,” said Rosenberg. “In seeing a higher mortality in those with lower stage disease, this also reinforces the importance of young cancer survivors understanding their ongoing medical needs even after treatment is over. And as health professionals, we need to continue to plug these patients into survivorship programs that can help educate them about and address their long-term health needs.”
Potential for improvement with the Affordable Care Act
Rosenberg said that broader insurance coverage and access to health care through the Affordable Care Act (ACA) may help improve the disparate survival outcomes for young people. While the ACA has made strides in improving coverage for those up to age 26 by extending access to parental plans, research shows that individuals in their late 20s and early 30s remain the least likely to be insured.
Rosenberg urges young people to understand the importance of having their own personal insurance policy if something does go wrong. She also calls for health care providers to advocate for insurance enrollment for adolescents and young adults.
“There is great potential to improve access to healthcare with the ACA in place,” said Rosenberg. “As health professionals we need to continue to help young people understand that they can get sick, and their ability to access proper, life-long medical care is essential for their wellbeing.”