Cancer and the Uninsured

According to a new American Cancer Society report examining the impact of health insurance status on cancer treatment and survival, uninsured Americans are less likely to get screened for cancer, more likely to be diagnosed with an advanced stage of the disease, and less likely to survive that diagnosis than their privately insured counterparts.

"This report clearly suggests that insurance and cost-related barriers to care are critical to address if we want to ensure that all Americans are able to share in the progress we have achieved by having access to high-quality cancer prevention, early detection, and treatment services," said Otis Brawley, MD chief medical officer of the American Cancer Society.

http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Report_Links_Health_Insurance_Status_With_Cancer_Care.asp?sitearea=NWS&viewmode=print&

For all cancers combined, the ACS researchers found that uninsured patients were 1.6 times as likely to die within 5 years compared to individuals with private insurance.

An earlier article by the American Cancer Society reports” People without health insurance and those on Medicaid are more likely to be diagnosed with advanced stages of cancer than those with private health insurance,”

http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Uninsured_More_Often_Diagnosed_with_Advanced_Cancer.asp

It's important to note that although variations in health insurance coverage likely contribute to racial and ethnic disparities in cancer outcomes, those disparities persist for several outcomes even when differences in insurance status are accounted for," said Elizabeth Ward, PhD.

People with lower incomes were less likely to have insurance, the report found. And those without insurance were less likely to use certain health services. About 54% of uninsured patients aged 18 to 64 did not have a usual source of health care. About 26% delayed care due to cost, while nearly 23% did not get care because of cost. An estimated 23% did not get prescription drugs because of the expense.

"For too many hardworking 'average Americans' paying for cancer treatment means not paying rent, mortgage (resulting in foreclosure or eviction), or utility bills, or even going hungry," wrote Elmer Huerta, MD, American Cancer Society president, in an accompanying editorial.

These statistics are true and uninsured and underinsured are more at risk than Americans with better health care coverage. However free and low cost services are available to assist the uninsured and underinsured.

It was mentioned in the article those uninsured or on Medicaid were more likely to be diagnosed in later stages. Yet Medicaid covers cancer screening and treatment and the Department of Health for each state has set up programs in conjunction with the Centers for Disease Control and Prevention for free or low cost screening.

The Centers for Disease Control and Prevention (CDC) initiated a nationwide program in 1990 aimed at reducing deaths from cancer through education, outreach, and screening.

http://www.cdc.gov/cancer/nbccedp/

http://www.cdc.gov/cancer/colorectal/basic_info/screening/

http://www.cdc.gov/cancer/screening.htm

http://apps.nccd.cdc.gov/cancercontacts/nbccedp/contacts.asp

Most of these programs are run by the Department of Health for each state such as in Pennsylvania by Adiago Health
http://www.fhcinc.org/pages/healthcare/cancer.htm
or Illonois
http://cancerscreening.illinois.gov/
California
http://www.dhs.ca.gov/cancerdetection/
Rhode Island
http://findarticles.com/p/articles/mi_qa4100/is_200309/ai_n9272104
New York
http://www.freecancerscreening.com/2007/07/manhattan-ny-free-cancer-screening.html

The American Academy of Dermatology also offers free skin cancer screening

http://www.aad.org/public/exams/screenings/index.html


The article also stated that the people with lower incomes were most likely to be uninsured due to the cost for health insurance and whereas this may be true assistance is available for treatment. There are many programs for low income people to receive free or low cost medication. Many of the individual drug manufacturers as well offer programs to cover their medications as well.

http://www.healthfinder.gov/news/newsstory.asp?docID=611094

http://www.health.gov/

http://www.freemedicinerevolution.com/?gclid=CMP0xo3Mt5ACFUWoGgodGnvnKg

https://www.pparx.org/Intro.php

http://www.needymeds.com/

http://www.merck.com/merckhelps/

http://www.themedicineprogram.com/

http://www.nami.org/Content/ContentGroups/Helpline1/Prescription_Drug_Patient_Assistance_Programs.htm

http://www.pharma.us.novartis.com/about-us/our-patient-caregiver-resources/pap-enrollment.jsp?usertrack.filter_applied=true&NovaId=2229644997704410576

http://www.edhayes.com/indigent.html

http://www.phrma.org/

http://www.qdrug.com/sf/

http://www.familiesusa.org/404.html

http://familiesusa.org/issues/uninsured/about-the-uninsured/

Cancer Care has programs to assist with financing treatment and care.

http://www.cancercare.org/get_help/assistance/index.php

I do agree with the American Cancer Society that the uninsured and underinsured do have higher incidents of advanced cancer and may not receive the proper treatment but I also feel that we need to explore and eliminate other causes as well.

As it has been mentioned earlier many people without insurance are low income or unemployed. Poor nutrition and bad health care habits such as smoking and sun exposure may be factors also. Many are poorly educated and maybe unaware of symptoms or uncertain of treatments. or not follow the prescribed treatment as ordered. Many immigrant groups may also have cultural or religious beliefs against treatments.

http://www.cbcrp.org/research/PageGrant.asp?grant_id=1803

http://jnci.oxfordjournals.org/cgi/reprint/jnci%3b96/1/10.pdf

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1618773

There are many options available for care no matter your income or coverage but I believe that education is necessary to let people know what is available and how they can help themselves.

Most importantly emphasis should be made to instruct on:

Good Health Habits to prevent cancer- No smoking, good nutrition, medical follow up

Instruction in warning signs and symptoms, treatment options

Free and low cost screening and treatment is available and where it can be obtained.

Additional resources

http://coloncancer.about.com/od/screening/a/Uninsured.htm

http://www.cancer.gov/cancertopics/factsheet/support/financial-assistance