(HealthDay News) — Disruptions in health insurance coverage are common and are associated with poorer cancer care and survival, according to a review published online in the Journal of the National Cancer Institute.

K. Robin Yabroff, PhD, from the American Cancer Society in Atlanta, and colleagues conducted a systematic literature review to identify studies of health insurance coverage disruptions and cancer care and outcomes published between 1980 and 2019.

Based on 29 included studies, the researchers reported that coverage disruptions were studied for impact on prevention or screening (31.0%), treatment (13.8%), end-of-life care (10.3%), stage at diagnosis (44.8%), and survival (20.7%). For patients age-eligible for breast, cervical, or colorectal cancer screening, coverage disruptions occurred for 4.3 to 32.8% of individuals. Medicaid coverage was gained only at or after cancer diagnosis for 22.1 to 59.5% of patients covered by Medicaid. There were significant associations between coverage disruptions and lower receipt of prevention, screening, and treatment. Compared with cancer patients without disruptions, Medicaid disruptions were associated with a significantly greater likelihood of having advanced-stage cancer (odds ratios, 1.2 to 3.8) and worse survival (hazard ratios, 1.28 to 2.43).

“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,” Yabroff said in a statement. “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.”

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Yabroff KR, Reeder-Hayes K, Zhao J, et al. Health Insurance Coverage Disruptions and Cancer Care and Outcomes: Systematic Review of Published Research. J Natl Canc Inst.

Tsui J, Sabik LM, Cantor JC. Understanding the impact of insurance coverage across the cancer care continuum: Moving beyond fragmented systems and cross-sectional data to inform policy. 
J Natl Cancer Inst. doi: 10.1093/jnci/djaa049

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