Disruptions in Health Insurance Coverage and Cancer Care, Survival

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A new study published by Yabroff et al in JNCI: The Journal of the National Cancer Institute found disruptions in health insurance coverage are common in the United States and are associated with poorer cancer care and survival.

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

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To learn more, investigators 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.

Studies evaluated associations between coverage disruptions and prevention or screening (31.0%), treatment (13.8%), end-of-life care (10.3%), cancer stage at diagnosis (44.8%) and survival (20.7%). 


In the studies analyzed, 4.3% to 32.8% of adults who were an eligible age for breast, cervical, and colorectal cancer screenings experienced coverage disruptions. Between 22.1% and 59.5% of patients who were eventually covered by Medicaid gained coverage only at or after cancer diagnosis. Those with Medicaid 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 were more likely to 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.”

The study authors concluded, “Health insurance coverage disruptions are common and adversely associated with receipt of cancer care and survival. Improved data infrastructure and quasi-experimental study designs will be important for evaluating the associations of federal and state policies on coverage disruptions and care and outcomes.”

Disclosure: For full disclosures of the study authors, visit

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®.