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Impact of Health Insurance Status on Prostate Cancer Treatment Modality Selection in the United States

Bledsoe, Trevor J., MD*; Park, Henry S., MD, MPH*; Rutter, Charles E., MD*; Aneja, Sanjay, MD*; Nguyen, Paul L., MD; Yu, James B., MD, MHS*

American Journal of Clinical Oncology: November 2018 - Volume 41 - Issue 11 - p 1062–1068
doi: 10.1097/COC.0000000000000423
Original Articles: Genitourinary

Objectives: A variety of treatment modalities are available for the management of clinically localized prostate cancer in the United States. In addition to clinical factors, treatment modality choice may be influenced by a patient’s insurance status. Using a national data set, we investigated the relationship between insurance status and prostate cancer treatment modality selection among nonelderly men in the United States.

Methods: Nonelderly men age 18 to 64 years treated for localized prostate cancer from 2010 to 2014 were identified within the National Cancer Database. Patients with no insurance, Medicaid, or private insurance were included. The χ2 and multivariable logistic regression analyses were used to evaluate the association of insurance status, other demographic and facility factors, and D’Amico risk classification with treatment modality.

Results: We identified 135,937 patients with either no insurance (2.8%), Medicaid (4.2%), or private insurance (92.9%) treated for prostate cancer who underwent cancer-directed treatment or active surveillance between 2010 and 2014. Patients with private insurance were more likely to receive minimally invasive surgery (61.4% vs. 35.4%, respectively; P<0.001) and less likely to receive external beam radiotherapy (10.9% vs. 26.9%, respectively; P<0.001) than patients with no insurance. On multivariable analysis, among patients with no insurance and private insurance, private insurance was the strongest predictor of receipt of minimally invasive surgery (adjusted odds ratio, 2.61; 95% confidence interval, 2.44-2.79; P<0.001).

Conclusion: Insurance status is a strong predictor of prostate cancer treatment modality among nonelderly men in the United States.

*Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT

Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Boston, MA

H.S.P. received honoraria and travel expenses from Varian Medical Systems Inc. C.E.R. received an honorarium from Elekta AB, unrelated to the current work. P.L.N. has consulted for Ferring, Medivation, and Genome Dx. J.B.Y. receives research grant funding from 21st Century Oncology unrelated to the current work. The other authors declare no conflicts of interest.

Reprints: Trevor J. Bledsoe, MD, Department of Therapeutic Radiology, Smilow Cancer Hospital, 35 Park Street, New Haven, CT 06520. E-mail:

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