Study Finds Insurance Status Affects Survival in Glioblastoma

Being insured by Medicaid may affect the prognosis of a patient with GBM, according to a recent study. 
BY Katie Kosko
PUBLISHED August 24, 2016
Insurance status appears to play a significant role in survival rates of patients with glioblastoma multiforme (GBM), according to a study conducted by a team of researchers at Johns Hopkins University School of Medicine.

Researchers found that patients with private insurance or Medicare were diagnosed with smaller GBM tumors and lived longer compared with those who had Medicaid insurance or no insurance at all.

“The worst cancer a patient can have in the neurosurgery field is GBM,” says Wuyang Yang, a research fellow in the Department of Neurosurgery and one of the authors on the study, in an interview with CURE. “We have suspected that there is a disparity in the access to health care, so we thought it would be interesting to study insurance status with cancer survival.”

The authors used the Surveillance, Epidemiology, and End Results (SEER) national database to analyze patients 18 years and older with GBM, who were first diagnosed between 2007 and 2012. According to the study results, published in the journal Cancer, survival analysis between insurance status and GBM-related death was performed using an accelerated failure time model.

Of the 13,665 patients examined, 558 (4.1 percent) were uninsured, 1,516 (11.1 percent) were covered under Medicaid and 11,591 (84.8 percent) had non-Medicaid (Medicare or private) insurance. Patients with insurance were more likely to be white, married, female, who also had a smaller tumor size at diagnosis.

Risk factors for shorter survival in the study included being a male, older, having a large tumor at diagnosis and being uninsured or insured under Medicaid.
“We took in a few factors with insurance, so that the factors were automatically adjusted in a single model,” Yang says. “We found that age is definitely associated with cancer survival, as well as marital status and tumor size. Even adjusting for these factors, insurance status stands out as most significant, so it means that there is something within the insurance that is causing this to happen.”

Researchers noted that insurance may vary in these patients with regard to flexibility of coverage and level of insurance.

“Although the specific type of insurance was not included in the SEER data set, the difference in survival time between uninsured patients and those with non-Medicaid insurance in the current study indicated a differentiation effect of socioeconomic status on the survival status of patients with glioblastoma on a more general scale,” wrote the authors.

The next step in the process is to conduct additional studies in order to confirm that access to health care is the reason for the differences in survival rates among patients with GBM. Yang says researchers are not positive at this time about the underlying reason.

Yang adds that medical professionals can help patients who come to them by educating them about GBM and explaining that regular follow-ups are important.
“This is an area of interest right now and we wish to use maybe some institution databases instead of just national databases to answer some of the insurance or socioeconomic questions associated with neurosurgical diseases,” says Yang.
 
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