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Disruptions in Health Insurance Coverage Are Common and Affect Cancer Care and Survival
Apr 27, 2020
New review finds breaks in coverage affect cancer treatment and outcomes
Our findings were consistent across multiple cancer sites, with several studies finding a ‘dose-response’ relationship, meaning the longer the disruption, the worse the care

A new study finds disruptions in health insurance coverage are common in the United States and are associated with poorer cancer care and survival. The study appears in JNCI: The Journal of the National Cancer institute.

For years, experts have known that lack of health insurance coverage is associated with poor access and receipt of cancer care and survival in the United States. Meanwhile, disruptions in coverage are common among low-income populations and little is known how these disruptions can affect cancer care, from prevention and screening to diagnosis, treatment and survival.

Disruptions can be caused by gaps in coverage, or transitions between types of coverage (e.g., public and private) or between specific health insurance plans.

To learn more, investigators  led by Robin Yabroff of the American Cancer Society conducted a systematic review of studies of health insurance coverage disruptions and cancer care and outcomes published between 1980 and 2019. They identified 29 observational studies for analysis.

In those studies, from 4.3% to 32.8% of adults experienced coverage disruptions. Those with coverage disruptions were less likely to receive cancer prevention or screening, and if diagnosed with cancer, they were more likely to have advanced disease, were less likely to receive treatment, and have worse survival than their counterparts without coverage disruptions.

“Our findings were consistent across multiple cancer sites, with several studies finding a ‘dose-response’ relationship, meaning the longer the disruption, the worse the care,” said Robin Yabroff, PhD, lead author of the study. “The consistency of these findings across the cancer control continuum in our review highlights how important it is to minimize breaks in health insurance coverage to address cancer disparities and promote health equity.”

Article: Health Insurance Coverage Disruptions and Cancer Care and Outcomes: Systematic Review of Published Research, JNCI: Journal of the National Cancer Institute, DOI 10.1093/jnci/djaa048

Editorial: Understanding the impact of insurance coverage across the cancer care continuum: Moving beyond fragmented systems and cross-sectional data to inform policy; Tsui et al. JNCI: Journal of the National Cancer Institute, DOI: 10.1093/jnci/djaa049