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Medicaid Recipients, Uninsured Less Likely To Survive Lung Cancer

Oregon Health & Science University Knight Cancer Institute study of treatment outcomes at hospitals nationwide uncovers disparities in when patients get diagnosed, how they fare

How successful would you be in battling lung cancer?

The answer could depend on your health insurance. Patients with private insurance or Medicare are more likely to survive lung cancer than those covered by Medicaid or without insurance, according to a review of data collected on patients who received their care at hospitals throughout the United States.

The study, conducted by the Oregon Health & Science University Knight Cancer Institute, found that Medicaid recipients had a higher incidence of lung cancer and the disease was typically caught at a later stage. Their survival rates, even when adjusted for their stage of cancer at the time of diagnosis, were lower than those with private insurance or Medicare. They also were less likely to have surgery or receive radiation therapy. In fact, the study found that patients on Medicaid were the most likely to die the same month they received their diagnosis. They also were less likely to be treated at major health-care centers, which typically have more experience with the disease.  

The study’s findings, published in a recent edition of the American Journal of Respiratory and Critical Care Medicine, have sweeping implications for public health. Lung cancer is the second most common cancer in men and women and it’s the leading cause of cancer-related death. As a result, it’s crucial to understand the cause of even small disparities in how patients fare with the disease, said Christopher Slatore, M.D., the study’s lead author who holds joint appointments with the OHSU Knight Cancer Institute and the Portland VA Medical Center.

“The role of insurance is so important because it’s something that we can change,” Slatore added.
The OHSU Knight Cancer Institute is committed to lowering the rate of cancer-related deaths in Oregon.

About 20 percent of adults in the United States who are younger than 65 are uninsured. Lung cancer patients without insurance may do poorly because they might not seek help until their disease is more advanced and more difficult to treat.

In addition to the role of insurance, multiple factors likely play a role in the lung cancer disparities that were associated with insurance status. For instance, patients on Medicaid are more likely to be current smokers, which may also contribute to their increased risk of death when undergoing lung-cancer treatments such as surgery or chemotherapy. This group is also less likely to have access to treatments to help them stop smoking.

Factors such as income, education and behavior also are related to a patient’s access to health care, and these factors have an impact on a patient’s ability to survive lung cancer.  In general, the studies that contributed to the review could not measure these other factors, so the contribution of insurance status alone to lung cancer care disparities is difficult to quantify.  

As a result, more exploration is needed to get at precise reasons why the disparities exist, Slatore said, adding, “It will be interesting to see what happens in five to 10 years with changes in health insurance.”

The American Thoracic Society sponsored the study, titled “Insurance Status and Disparities in Lung Cancer Practices and Outcomes.” It was based on a systematic review of studies published on topics related to insurance status and lung cancer outcomes. Slatore received salary support from the National Institutes of Health (NIH) for his work on a separate project. This study also is the result of work supported by resources from the Portland VA Medical Center and VA Puget Sound Health Care System, Seattle. Neither the NIH nor the Department of Veterans Affairs had a role in the conduct of the study, in the collection, management analysis or interpretation of data.

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About the OHSU Knight Cancer Institute
With the latest treatments, technologies, hundreds of research studies and approximately 400 clinical trials, the OHSU Knight Cancer Institute is the only National Cancer Institute-designated Cancer Center between Sacramento and Seattle— an honor earned only by the nation's top cancer centers. The honor is shared among the more than 650 doctors, nurses, scientists and staff who work together at the OHSU Knight Cancer Institute to reduce the impact of cancer.  Visit  or

About OHSU
The Oregon Health & Science University is the state's only health and research university, and Oregon's only academic health center. OHSU is Portland's largest employer and the fourth largest in Oregon (excluding government). OHSU’s size contributes to its ability to provide many services and community support activities not found anywhere else in the state. OHSU serves patients from every corner of the state, and is a conduit for learning for more than 3,400 students and trainees. OHSU is the source of more than 200 community outreach programs that bring health and education services to every county in the state.

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