Medicare Eligibility May Be Associated With More Cancer Diagnoses

The eligible age of 65 years for Medicare may be discouraging patients from getting screenings and tests as they wait for more health coverage.

The age for Medicare eligibility may be associated with more cancer diagnoses, resulting in lower long-term cancer-specific mortality in lung, breast, colon or prostate cancer, according to a recent study.

In the United States, those eligible to receive Medicare include those who are 65 years or older, younger people with disabilities and people who have received a diagnosis of end state renal disease (permanent kidney failure).

“This is the first study to show that cancer patients are delaying receiving appropriate medical care for cancers as they approach Medicare age, presumably in order to avoid the costs associated with that care. We also show that delaying care in this way results in reduced cure rates from the cancers,” explained lead study author Dr. Joseph Shrager, Professor and Chief, Division of Thoracic Surgery at Stanford Medicine in Stanford, California, in an interview with CURE®.

Shrager describes this subset of patients as the “perfect storm” as “it’s the age at which many people begin to develop cancers and other life-threatening conditions, but at the same time it’s the age that many people are uninsured or underinsured because of unemployment, early retirement, etc.”

Higher Cases, Lower Survival

In the study — that was published in the journal Cancer — Shrager and colleagues looked at patients aged 61 to 69 years who received a diagnosis of lung, breast, colon, or prostate cancer between 2004 and 2016. In the database, it was identified that 134,991 patients received a diagnosis of lung cancer, 175,558 with breast cancer, 62,721 with colon cancer and 238,823 with prostate cancer, between these years.

Researchers then separated the patients into two groups, one of uninsured patients who were 61 to 64 years old (pre-Medicare group) and those patients who were 65 to 69 years old (post-Medicare group),

“We showed, first of all, that the number of patients with the four most common cancers who were uninsured falls from around 5% to around 0.8% at age 65 — the age of Medicare eligibility. We then showed that the yearly rate of rise in cancer diagnoses for these cancers jumped at the 64- to 65-year-old transition vs all other transitions between 60 and 69 years,” Shrager said.

Study results showed that the number of cancer diagnosis was highest at 65 years, leading to a five-year cancer specific mortality increase compared to those in the post-Medicare group for lung (86.3% vs 78.5%), breast (32.7% vs 11.0%), colon (57.1% vs 35.6%) and prostate (16.9% vs 4.8%) cancers.

“For example, the number of lung cancer diagnoses made each year was rising at about 4% per year prior to 65 (this makes sense, because the older you are, the more likely you are to get a cancer), but at 65 it rose 8% or double the earlier rate. And after 65, it fell back to the earlier approximately 4% rate,” Shrager said, adding that this means patients are either ignoring symptoms that may have led to a diagnosis of cancer or not getting the recommended screening tests for cancer prior to 65 years of age.

The study also showed that this may affect survival data with overall survival about 10% greater in the post-Medicare group, despite their age.

The Importance of Expanding Medicare

For nearly every cancer, waiting to get diagnosed and treated could be the difference between having a high chance of cure and no chance of cure, according to Shrager.

Most cancer diagnosis at this time were stage 1, which Shrager noted as a surprise since he hypothesized that later stage cancer diagnosis would be higher. “My hypothesis to explain this finding is that it was more the screening-type of testing, rather than seeking attention for symptoms, that patients are delaying as they approach age 65,” he added. “The presence of symptoms is often associated with later stage cancers — I suspect that if you have symptoms that you are worried about, you are more likely to be scared and seek attention despite the costs before you turn 65. But if it’s ‘just’ a screening test, you are more likely to take your chances and wait until you are 65, avoiding the cost of the test if you are uninsured or have a high copay for the test.”

According to Shrager, these data highlight a need to expand the eligibility age for Medicare. “While the urge to wait until you turn 65 to get expensive screening tests or diagnostic procedures, if you have high co-pays or no insurance at all, is understandable, patients need to understand that they may be risking their lives by doing this,” he concluded. “And our leaders need to understand that by expanding Medicare to a lower age cut-off, they would be frankly saving many patients from dying of cancer.”

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