MUSC Hollings Cancer Center lung cancer researcher Gerard Silvestri, M.D., found that a lack of insurance leads to worse cancer survival than for those with Medicare, in a paper published in the May issue of Health Affairs. This work, a joint effort between Silvestri and researchers at the American Cancer Society, highlights the current dire barrier in medical care: Many people cannot take advantage of the newer potentially lifesaving treatments due to the high costs.

Silvestri said the research began last year, inspired by the hotly debated topic of expanding Medicare insurance coverage to those under 65. Using the National Cancer Database, which contained data collected between 2004 through 2016 from over 1.2 million cancer patients, Silvestri began investigating lung cancer outcomes based on insurance status and age.

The findings in lung cancer were so surprising that the American Cancer Society recommended looking at 1-year, 2-year, and 5-year survival rates across the 16 most common cancers, including lung, breast, colon and prostate cancer. Due to the large study population, comorbidities and other disease factors were able to be matched across these four groups: uninsured patients 60 to 64 years old, private insurance patients 60 to 64 years old, Medicare patients 66 to 69 years old and Medicare plus private insurance 66 to 69 years old.

Generally, when comparing cancer survival among patients with similar stages and types of cancer, younger patients have better outcomes than their older counterparts, Silvestri said. However, this study found that across all 16 cancer types those younger than Medicare age (60 to 64 years old) without health insurance had significantly worse survival than their older counterparts.

"Further, there was a dose response gradient across the different insurance groups. Uninsured younger patients had the lowest survival, followed by older Medicare patients without supplemental private insurance, then older Medicare patients with supplemental private insurance, with younger privately insured patients having the best survival. The survival difference was quite surprising," he said.

"Even in cancers with poor five-year survival amongst all insurance groups, the differences observed between uninsured individuals 60 to 64 years old versus individuals ages 66 to 69 years old could be seen at one and two years with Medicare patients having significantly better survival at those yearly landmarks compared to younger uninsured patients," explained Silvestri, an MUSC Health lung cancer pulmonologist at Hollings.

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