Health Services Research

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TU_39_2983 - Disparities in Patterns-of-Care for Uninsured Versus Insured Patients with Anorectal Carcinoma Referred for Radiation Therapy at an Urban Safety Net Hospital

Tuesday, October 23
1:00 PM - 2:30 PM
Location: Innovation Hub, Exhibit Hall 3

Disparities in Patterns-of-Care for Uninsured Versus Insured Patients with Anorectal Carcinoma Referred for Radiation Therapy at an Urban Safety Net Hospital
C. E. Mercado1, C. G. Morris1, M. S. Rutenberg2, and R. C. Nichols Jr3; 1Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, 2Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, 3University of Florida Health Proton Therapy Institute, Jacksonville, FL

Purpose/Objective(s): Health insurance status has been implicated in disparities of cancer care and treatment outcomes in various healthcare settings. This study compares the patterns-of-care and clinical outcomes of uninsured patients (UP) versus insured patients (IP) with anal and rectal carcinoma referred for radiotherapy at an urban safety net hospital in the southeastern United States.

Materials/Methods: Under institutional review board approval, we reviewed the medical records of newly diagnosed patients with anal or rectal carcinoma treated with adjuvant or definitive radiotherapy at a safety net hospital in the southeast. Patients with a minimum of 5 years of follow-up were retrospectively analyzed for the following factors: insurance status at the time of symptom emergence, patient demographics, stage at diagnosis, weight loss at diagnosis, date of first symptom onset, date of diagnosis, and overall survival.

Results: Sixty-five patients treated between May 2002 and August 2012 were eligible for analysis. The median follow-up for surviving patients was 8.3 years (range, 1-13.8). At symptom onset, there were 35 UP and 30 IP. The median age of UP was 52 years vs. 64 years for IP (p=0.0005). The interval between first symptom onset and date of tissue diagnosis was significantly delayed for UP patients (258.5 vs. 58 days; p=0.0013). The median interval between first symptom onset and treatment initiation was 314.5 days for UP versus 120 days for IP (p=0.0024). The median weight loss at diagnosis for UP was 10 lbs versus 0 lbs for IP (p=0.0158). The UP were more likely to present with T4 tumors when compared to IP (41% vs. 7%; p=0.0027). The overall survival rate at 5 years was 63% for both cohorts of patients.

Conclusion: Differences in health insurance status demonstrated a multitude of disparities in patterns of care, including a delay in diagnosis, more advanced stage disease, and delay in cancer treatment initiation in UP. Despite these differences, overall survival at 5 years was similar, although this may possibly be explained by the older age of patients in the IP cohort.

Author Disclosure: C.E. Mercado: None. C.G. Morris: None. M.S. Rutenberg: None. R. Nichols: None.

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