September 13, 2019
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Certain thyroid cancer treatments more likely with private health insurance

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Access to surgery and radioactive iodine therapy for papillary thyroid cancer is greater for adults with private health insurance than for those without insurance, and cancer severity at diagnosis is often less for those with insurance, according to findings published in Thyroid.

“Health insurance has a central role in enabling patients in the United States to both access and receive care,” Toni Beninato, MD, FACS, an assistant attending surgeon at NewYork-Presbyterian Hospital and an assistant professor of surgery at Weill Cornell Medical College at Cornell University, and colleagues wrote. “Papillary thyroid cancer patients, in particular, may be especially vulnerable to insurance-based diagnostic and treatment disparities given the wide range of therapeutic options for this disease.”

In a retrospective study, Beninato and colleagues evaluated the type of insurance used by 190,298 adults (median age, 48 years; 76.1% women) with papillary thyroid cancer, using data collected between 2004 and 2015 available in the American College of Surgeons’ National Cancer Database. The researchers also used the database to collect data on tumor sizes, cancer severity and treatments provided.

Among adults without health insurance, the researchers found that extrathyroidal extension was present in 25.2% of the population, lymphovascular invasion was present in 16.1%, distant metastases were present for 1.2%, and positive margins on the final pathology were present for 16.1%. In comparison, among those with private health insurance, extrathyroidal extension was present for 18.9%, lymphovascular invasion for 12%, distant metastases for 0.6%, and positive margins on the final pathology for 12.2% (P < .001 for all).

Thyroid surgery 2019 
Access to surgery and radioactive iodine therapy for papillary thyroid cancer is greater for adults with private health insurance than for those without insurance, and cancer severity at diagnosis is often less for those with insurance.
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The odds of presenting with microcarcinoma were greater for those with vs. without private insurance (OR = 1.51; 95% CI, 1.35-1.68). In addition, the odds of presenting with microcarcinoma were greater for those with Medicare (OR = 1.16; 95% CI, 1.05-1.3) and for those with Medicaid (OR = 1.35; 95% CI, 1.21-1.51) compared with those who did not have insurance.

The odds of undergoing total thyroidectomy (OR = 1.18; 95% CI, 1.01-1.37) and formal lymphadenectomy (OR = 1.22; 95% CI, 1.09-1.36) were greater for those with vs. without private insurance. The odds of undergoing adjuvant radioactive iodine treatment were 1.35 times higher for those with private insurance compared with those without insurance (OR = 1.35; 95% CI, 1.18-1.54).

“Privately insured patients were also more likely to receive more extensive treatments for their cancers on a stage-by-stage basis,” the researchers wrote. “This is concerning, because it is possible that the highest risk patients — those with stage IV disease — have the highest disparity in adjuvant treatment.”

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According to the researchers, there was no difference between those without insurance and those with either Medicare or Medicaid when it came to the odds of receiving these treatments. Additionally, the researchers noted that “patients with private insurance also had a survival advantage over those without insurance” after a thyroidectomy procedure, whereas there was a “disadvantage” for those on Medicaid.

“This study is the first to demonstrate that insurance status independently affects treatments provided to papillary thyroid cancer patients. Additionally, in agreement with previous reports, we found that privately insured patients had lower-risk cancers at diagnosis,” the researchers wrote. “Clinicians should be mindful of these disparities when considering appropriate treatments and take caution to ensure proper referral and follow-up for uninsured and underinsured patients.” – by Phil Neuffer

Disclosures: The authors report no relevant financial disclosures.