Barriers to Treatment in Limited-Stage Small Cell Lung Cancer

Key Points

  • Lack of insurance and Medicare/Medicaid insurance were associated with a reduced likelihood of combined-modality therapy.
  • Lack of insurance and Medicare/Medicaid insurance were associated with poorer survival.

In a study reported in JAMA Oncology, Pezzi et al found that lack of health insurance, including Medicare and Medicaid, was associated with not receiving combined-modality therapy in limited-stage small cell lung cancer (SCLC). They also found that lack of insurance was associated with poorer survival in these patients.

Study Details

The study involved data from 70,247 patients (55% female, median age = 68 years) from the National Cancer Database from 2004 through 2013.  Initial treatment was chemotherapy and radiation therapy in 55.5%, chemotherapy alone in 20.5%, radiation therapy alone in 3.5%, and neither in 20.0%. Median overall survival in these 4 groups was 18.2, 10.5, 8.3, and 3.7 months, respectively.

Effect of Insurance Type

On multivariate analysis, lack of insurance was associated with a lower likelihood of receiving chemotherapy (odds ratio [OR] = 0.65, P < .001) and radiation therapy (OR = 0.75, P < .001) vs private or managed care insurance. Medicare/Medicaid did not affect chemotherapy use, but both Medicaid (OR = 0.79, P < .001) and Medicare (OR = 0.86, P < .001) were associated with a lower likelihood of radiation therapy.

Also on multivariate analysis, lack of insurance (hazard ratio [HR] = 1.19, P < .001), Medicaid (HR = 1.27, P < .001), and Medicare (HR = 1.12, P < .001) were all associated with poorer survival vs private or managed care insurance. Receipt vs nonreceipt of chemotherapy (HR = 0.55, P < .001) and radiation therapy vs no radiation therapy (HR = 0.62, P < .001) were associated with improved survival.

The investigators concluded, “Substantial proportions of patients documented in a major U.S. cancer registry did not receive radiation therapy or chemotherapy as part of initial treatment for limited-stage SCLC, which, in turn, was associated with poor survival. Lack of radiation therapy delivery was uniquely associated with government insurance coverage, suggesting a need for targeted access improvement in this population. Additional work will be necessary to conclusively define exact population patterns, specific treatment deficiencies, and causative factors leading to heterogeneous care delivery.”

The study was supported by the National Cancer Institute.

Stephen G. Chun, MD, of the Division of Radiation Oncology at The University of Texas MD Anderson Cancer Center, is the corresponding author for the JAMA Oncology article. 

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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