Patients with metastatic renal cell carcinoma (RCC) with primary Medicaid or no medical insurance have worse survival outcomes compared to those with primary Medicare, according to findings from a recent study.
Results from this study, which were presented at the Kidney Cancer Research Summit, also demonstrated that patients with secondary insurance had superior survival without disease progression versus those with only primary insurance.
“Overall, our findings suggest that insurance status may serve as a determinant of clinical outcomes,” the study authors wrote in the abstract. “These hypothesis-generating data warranted external validation in prospective studies.”
Researchers analyzed data from 645 patients (73% men; median age at diagnosis, 60 years) with metastatic RCC from two National Cancer Institute-designated comprehensive cancer centers who received a diagnosis between 1990 and 2022.
The available insurance information was categorized as Medicare (53.3%), private insurance (38.8%) and Medicaid/no insurance (7.9%). In addition, secondary insurance was defined as either the absence or presence of secondary medical coverage.
Several outcomes were assessed including progression-free survival (the time during and after treatment when a patient with cancer is alive without worsening disease) and overall survival (the time when a patient with cancer is still alive). These outcomes were examined to determine the potential impact of insurance status.
The most common first-line treatments given to patients with metastatic RCC in this study were monotherapy with targeted agents (66.4%), targeted/immunotherapy combinations (10.2%) and dual immunotherapy (13.6%).
The median progression-free survival for all patients in the study was 6.6 months. When assessed by insurance status, the median progression-free survival was 7.7 months for patients with Medicare, 5.5 months for those with private insurance and 4.9 months for patients with Medicaid/uninsured. Researchers noted a significant difference in progression-free survival among the insurance groups.
Secondary insurance status also showed a statistically significant difference in median progression-free survival, with 8.1 months in patients with secondary insurance compared with 6.1 months for those without it.
For overall survival, the median for all patients in the study was 36.8 months. There was a significant difference in overall survival in patients with primary Medicare (49 months), private insurance (28.5 months) or Medicaid/no insurance (21.6 months).
Overall survival did not differ significantly in patients with or without secondary insurance.
Superior median progression-free survival and overall survival were observed in patients with primary Medicare versus Medicaid/no insurance. Researchers noted that patients with private insurance had a lower risk for progression and death versus those with Medicaid/no insurance, although the difference was not statistically significant.
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