Study: Insured cancer patients do better

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Since we have had the great debate on the healthcare in the nation. I found this and thought people on here might like this..

ATLANTA - Uninsured cancer patients are nearly twice as likely to die within five years as those with private coverage, according to the first national study of its kind and one that sheds light on troubling health care obstacles.

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People without health insurance are less likely to get recommended cancer screening tests, the study also found, confirming earlier research. And when these patients finally do get diagnosed, their cancer is likely to have spread.

The research by scientists with the American Cancer Society offers important context for the national discussion about health care reform, experts say "? even though the uninsured are believed to account for just a fraction of U.S. cancer deaths. An Associated Press analysis suggests it is around 4 percent.

Those dealing with cancer and inadequate insurance weren't surprised by the findings.

"I would just like for something to be done to help someone else, so they don't have to go through what we went through," said Peggy Hicks, a Florida woman whose husband died in August from colon cancer.

Edward Hicks was uninsured, and a patchwork health care system delayed him from getting chemotherapy that some argue might have extended his life.

"He was so ill. And you're trying to get him help and you can't, you can't," said his 67-year-old widow.

The new research is being published in CA: A Cancer Journal for Clinicians, a cancer society publication. In an accompanying editorial, the society's president repeated the organization's call for action to fix holes in the health care safety net.

"The truth is that our national reluctance to face these facts is condemning thousands of people to die from cancer each year," Dr. Elmer Huerta wrote.

Hard numbers linking insurance status and cancer deaths are scarce, in part because death certificates don't say whether those who died were insured.

An Associated Press estimate "? based on hospital cancer deaths in 2005 gathered by the U.S. Agency for Healthcare Research and Quality information and other data "? suggests that at least 20,000 of the nation's 560,000 annual cancer deaths are uninsured when they die. Experts said that estimate sounds reasonable.

That's around 4 percent of the total cancer death toll. One reason is that most fatal cancers occur in people 65 or older "? an age group covered by the federal Medicare program. Another is that more than 80 percent of adults under 65 have some form of coverage, including private insurance or the Medicaid program for the poor, according to various estimates.

Some are enrolled in Medicaid or other programs after diagnosis, when the condition worsens and their finances erode. But such 11th hour coverage can be too late; early detection is the key to catching many cancers before they've grown beyond control, experts said.

"Insurance makes a big difference in how early you are detecting disease," said Ken Thorpe, an Emory University health policy researcher.

In the new study, researchers analyzed information from 1,500 U.S. hospitals that provide cancer care. They focused on nearly 600,000 adults under age 65 who first appeared in the database in 1999 and 2000 and who had either no insurance, private insurance or Medicaid.

Researchers then checked records for those patients for the five years following. They found those who were uninsured were 1.6 times more likely to die in five years than those with private insurance.

More specifically, 35 percent of uninsured patients had died at the end of five years, compared with 23 percent of privately insured patients.

Earlier studies have also shown differences in cancer survival rates of the uninsured and insured, but they were limited to specific cancers and certain geographic areas.

The new findings are consistent across different racial groups. However, the fact that whites have better survival rates cannot be explained by insurance status alone, said Elizabeth Ward, the study's lead author.

The researchers were not able to tell if the numbers were influenced by patients' education levels, or by other illnesses.

Experts said the study also hints at problems with quality of care after diagnosis: such as whether the patient got the appropriate operation from a high-quality surgeon, whether the tumor was thoroughly evaluated by a high-quality pathologist, and whether there was access to needed chemotherapy and radiation.

"The differences that we see in outcomes after people are diagnosed, even among those with early stage disease, suggests that problems with quality of care may be an important reason," said Dr. John Ayanian, professor of medicine and health care policy at Harvard Medical School. He didn't participate in the cancer society study.

The study makes an even stronger statement about the role insurance plays in the timing of screenings and how that can raise the likelihood of a late-stage diagnosis, experts said.

A Kaiser Family Foundation survey last year of 930 households that dealt with cancer found that more than one in four uninsured patients delayed treatment "? or decided not to get it "? because of the cost.

Such was the case of Edward Hicks.

The retired laborer, had surgery for colorectal cancer in 2005 and was thought to be clear of the disease. Chemotherapy was suggested after the surgery, but he didn't get it.

In February of this year, his wife grew worried when he lost energy and appetite. In April, he told her he felt a lump in his stomach.

Hicks, who lived in Fort Meade, Fla., couldn't get an appointment with a specialist, but a family doctor checked him into a hospital and specialists saw him in late May. They said he was terminal but that chemotherapy might extend his life a little, his wife said.

She was able to get donated chemotherapy drugs from a pharmaceutical company, but it took time to arrange the treatments, which didn't start until mid-June. Meanwhile, her husband's health deteriorated. In July, after just a few treatments, he stopped the chemo, saying it was too hard. He died on Aug. 21, at age 64.

Friends and family told Peggy they believe he would have lived longer had he got chemo earlier, when he was stronger. She doesn't agonize over that, she said, trusting in God's will.

But the devil's in her mailbox "? she is facing a $21,000 hospital bill and other costs from his death.

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Here is a related article I had read some time back. It reinforces the above article.

http://www.msnbc.msn.com/id/17929063/

Frustrated by the U.S. health care system, an Oklahoma doctor being treated for colon cancer decided to write an essay for a medical journal.

But it's not his own care that upset him. It's the plight of the uninsured "? specifically a patient of his who was the same age, had the same disease, yet couldn't afford the treatment he got.

Today, Dr. Perry Klaassen, 67, is still working part-time in an Oklahoma City clinic, six years after his diagnosis. Shirley Searcy, his patient, died 18 months after hers.

Klaassen's treatment included surgery two days after diagnosis and costly new drugs that have kept him going despite cancer that has now spread to his lungs, liver and pelvis.

"I received the most efficient care possible. I was 61 years old and had good group health insurance through my workplace,"? he wrote in the essay.

The doctor didn't name Shirley Searcy in his March 14 article. After all he'd been through, he couldn't remember her name. But for days he dug through old medical files searching for her identity after he was interviewed by The Associated Press. He realized he could shine a more powerful light on the plight of the uninsured if her story could be told more fully.

And it is a story that's far from unique. The widowed mother of eight grown children, Searcy had little money. When she began to sense she might be sick, she put off going to the doctor for a year because she knew she couldn't pay the medical bills. Deeply religious, she put her faith in God, according to her family.

By the time she saw Klaassen, her cancer had spread from her colon to her liver. She had surgery but rejected chemotherapy.

"She just really didn't feel like she wanted to endure what that would cost physically or financially,"? said her daughter-in-law, Karen Searcy.

Shirley Searcy died Dec. 22, 2003, about 18 months after her diagnosis.

Life or death issue
While recent attention has focused on high-profile cancer patients like Elizabeth Edwards and Tony Snow, who have the means and insurance to pay for the best treatment, there are tens of thousands of tragic, unseen cancer cases like Searcy's "? people whose lack of insurance stops them from seeking care when they should.

An estimated 112,000 Americans with cancer have no health insurance, according to Physicians for a National Health Program.

And that's only cancer. Among the 45 million Americans who have no health insurance, there are countless people with chronic and developing health problems who are risking the same kind of fate that took Shirley Searcy's life.

Klaassen's essay in the Journal of the American Medical Association illustrates the issue "right there up close and personal,"? said editor Dr. Catherine DeAngelis.

It underscores that insurance can be a life or death issue, said Paul Ginsburg, president of the Center for Studying Health System Change, a nonpartisan policy research organization. "The cost of health insurance has been going up faster than people's incomes,"? he said.

U.S. spending on health care totaled $2 trillion last year and economists in February projected it will nearly double by 2016.

Said DeAngelis: "We have the richest country in the world and I think the poorest health delivery system in the developed world. It's really sad."?

Klaassen no longer sees patients but works part-time as medical director of an Oklahoma City group that recruits doctors to give free care to needy patients.

Always healthy and vigorous, his diagnosis in 2001 came as a shock.


He went to his family physician after experiencing an annoying pain in his lower abdomen for a few weeks. A CT scan showed possible inflammation, but his doctor recommended a colonoscopy, the gold-standard test for detecting colon cancer.

Klaassen had the test within two weeks. When the specialist ready with the results asked, "Is your wife with you?"? Klaassen wrote, "I knew immediately that I had colon cancer."?

His wife was out of town, and needing someone to share the awful news with, he turned to a physician friend "and I broke down and cried."?

Surgery two days later showed the disease had spread outside the colon wall and to nearby lymph nodes. It was not quite as advanced as Mrs. Searcy's, whose disease had spread to the liver.

Shirley Searcy married young and had her first child in her teens. Her mechanic husband died in a 1978 car crash, leaving her to raise the family alone. Social Security helped, but the Searcys never had anything extra, family members said.

"Life dealt her more I guess than some people have been dealt,"? her daughter-in-law said.

She didn't work outside the home, didn't venture often beyond her four acres and the frame ranch house where she raised her children in the humble town of Blanchard, about 30 miles from Oklahoma City. In her later years, reading stories to her dozens of grandchildren was a favorite pastime, family members said.

She'd figured she'd live long enough to qualify for Medicare at age 65, they said, but she missed it, by just a year.

She'd had symptoms for at least a year before going to the doctor, her family said.

"She put off going because of no health insurance and she wanted to trust the Lord. She was hoping to be healed,"? said her daughter, Melba Spalding.

A relative referred her to Klaassen, a primary care doctor in the city, because she'd had abdominal pain, lost weight, and had bloody stools. She'd been hospitalized several months before and urged to get a colonoscopy, but still hadn't had one when she went to see Klaassen.

With his own diagnosis fresh in his mind, Klaassen knew immediately that it was colon cancer. A colonoscopy weeks later confirmed the diagnosis and the family learned the disease was incurable.

The diagnosis was "heartbreaking to all of us,"? said Spalding, 50, the oldest of Mrs. Searcy's children. The family had always been close, and Mrs. Searcy "was pretty well the hub of it,"? she said.

With her colon diseased, Mrs. Searcy had a colostomy, surgery that creates an opening in the abdomen for waste removal, and worried about how to pay for all her medical supplies, Karen Searcy said. She didn't want to burden her family, but Karen said she and her husband, Kenneth, lived nearby and helped out.

Still, their own finances have sometimes been a struggle.

Karen said they had no health insurance when the first two of their four children were born. They needed help to pay for the births.

Now they're covered through Kenneth's job as a plywood salesman "? a godsend since he has diabetes, high blood pressure and high cholesterol and co-payments alone for his medicine have totaled $90 a month.

"There's a lot of mixed emotions about health care in my mind,"? Kenneth Searcy said. "You really can't afford it, but you can't afford not to have it."?

With insurance, Mrs. Searcy would have sought treatment sooner, family members said.

"I believe with all my heart that if she had gone to a doctor early on, that she would still be living,"? Karen Searcy said.

She said her mother-in-law held up pretty well after her surgery in January 2003. But by that Thanksgiving, when she could no longer make her holiday pies, the gravity of her situation finally hit her.

"She broke down and cried and she realized that her strength was gone,"? her daughter-in-law said.

Shirley Searcy died a month later.

Klaassen last saw his patient several months before her death, but kept in touch by phone, and her children said that was a comfort to her.

"Shirley spoke very highly of him,"? Karen Searcy said. "He was not just a doctor, he was a friend. Their situations being the same, I'm sure created a bond between them."?

Klaassen also thinks things would have turned out differently for Mrs. Searcy if she'd been insured.

"If she had survived at least a year more, she would have had new pills available to her,"? the same ones that have helped control his disease, Klaassen said.

"People think that everybody's taken care of, that there's a safety net,"? he said.

"People say ... nobody ever dies because they don't have insurance, and I say, "?Yeah, they do."?'