Health Insurance Status Affects Staging and Influences Treatment Strategies in Patients with Hepatocellular Carcinoma

Background Lack of health insurance is associated with poorer outcomes for patients with cancers amenable to early detection. The effect of insurance status on hepatocellular carcinoma (HCC) presentation stage and treatment outcomes has not been examined. We examined the effect of health insurance s...

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Bibliographic Details
Published in:Annals of surgical oncology 2010-12, Vol.17 (12), p.3104-3111
Main Authors: Zaydfudim, Victor, Whiteside, Martin A., Griffin, Marie R., Feurer, Irene D., Wright, J. Kelly, Pinson, C. Wright
Format: Article
Language:English
Subjects:
Antineoplastic Agents - economics
Carcinoma, Hepatocellular - economics
Carcinoma, Hepatocellular - pathology
Carcinoma, Hepatocellular - therapy
Catheter Ablation - economics
Combined Modality Therapy
Female
Healthcare Policy and Outcomes
Hepatectomy - economics
Humans
Insurance Coverage
Insurance, Health
Liver Neoplasms - economics
Liver Neoplasms - pathology
Liver Neoplasms - therapy
Liver Transplantation - economics
Male
Medicine
Medicine & Public Health
Middle Aged
Neoplasm Staging
Oncology
Registries
Retrospective Studies
Risk Factors
Surgery
Surgical Oncology
Survival Rate
Treatment Outcome
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Summary:Background Lack of health insurance is associated with poorer outcomes for patients with cancers amenable to early detection. The effect of insurance status on hepatocellular carcinoma (HCC) presentation stage and treatment outcomes has not been examined. We examined the effect of health insurance status on stage of presentation, treatment strategies, and survival in patients with HCC. Methods The Tennessee Cancer Registry was queried for patients treated for HCC between January 2004 and December 2006. Patients were stratified by insurance status: (1) private insurance; (2) government insurance (non-Medicaid); (3) Medicaid; (4) uninsured. Logistic, Kaplan–Meier, and Cox models tested the effects of demographic and clinical covariates on the likelihood of having surgical or chemotherapeutic treatments and survival. Results We identified 680 patients (208 private, 356 government, 75 Medicaid, 41 uninsured). Uninsured patients were more likely to be men, African American, and reside in an urban area (all P  
ISSN:1068-9265
1534-4681
DOI:10.1245/s10434-010-1181-2