Uninsurance, Medicaid Coverage Could Delay Colon Cancer Diagnosis

Health insurance type is a risk factor for delayed diagnosis of colon cancer, according to a research letter published in JAMA Network Open.

The researchers noted that less than four out of ten patients with colon cancer will be diagnosed in with early stages of the disease. This fact along with the disease’s death rate, which is the third-highest death rate among cancers when combined with rectal cancer, serves to highlight poor chronic disease prevention for this disease.

The researchers used data from the National Cancer Database from 2010 to 2017. In addition to examining colon cancer diagnoses in the database, they also looked at variables associated with the advanced pathologic stage, including surgical interventions and neoadjuvant therapy.

The demographic data set covered 208,085 patients while the advanced pathologic stage data set encompassed over 238,300 patients. The patients were nearly evenly split between stages one and two of colon cancer (49 percent) and stages three and four of colon cancer (51 percent). Nearly four in ten patients had commercial coverage, more than half had Medicare coverage, and 7.1 percent had Medicaid coverage.

Pathologic stage data details the surgical stage of colon cancer treatment. Advanced stages with higher numbers indicate more serious cancer presence.

Patients who experienced surgical resection and had no healthcare coverage or only Medicaid coverage tended to have advanced pathologic stages. The researchers noted that this result supports previous research which found that minimal health insurance coverage presented a risk factor.

Additionally, those who were more than 12.6 miles from their local medical facilities were more likely to have higher stages of colon cancer.

The researchers divided the patients’ travel needs into three segments: 12.6 miles to 50 miles from their medical facilities, 50.6 miles to 250 miles, and over 250 miles. They discovered that patients’ likelihood of being diagnosed with advanced stages of colon cancer increased as the mileage from their facilities increased.

Patients with higher travel times to a treatment center who lived in the northeast, mountain, or central regions of the US were at higher risk of developing advanced pathologic disease for colon cancer.

“The primary limitation of our study is that income and distance were calculated at the zip code rather than patient level, which may create bias,” the researchers noted.

“The findings of this study suggest that distance from the treating facility and insurance status are risk factors for the diagnosis of advanced-stage colon cancer among patients in the US. These findings are important as more rural hospitals are closing and care becomes more regionalized at high-volume centers. Interventions to provide transportation may be useful in the Mountain, Central, and Northeast regions, where patients living far from hospitals have greater risk for diagnosis of advanced-stage disease.”

In an effort to improve preventive care for colorectal cancer, the healthcare system has turned to a number of key payer strategies for colorectal cancer prevention. One of the biggest areas for improvement is in boosting preventive screenings for the disease.

During the height of the pandemic when access to screenings was low, health insurance companies and their partners issued chronic disease prevention kits for diseases like colon cancer and diabetes.

Since the disease disproportionately impacts Black members, individual payers have formed partnerships to advance health equity in colon cancer prevention.