Evidence map›Paper›PMID 32337585›Full record

SynthesisJournal of the National Cancer Institute2020

Health Insurance Coverage Disruptions and Cancer Care and Outcomes: Systematic Review of Published Research.

K Robin Yabroff, Katherine Reeder-Hayes, Jingxuan Zhao, Michael T Halpern, Ana Maria Lopez, Leon Bernal-Mizrachi, Anderson B Collier, Joan Neuner, Jonathan Phillips, William Blackstock and 1 more

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Journal of the National Cancer Institute, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 97 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
97citing papers in PubMed, 7 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

97 citing papers in PubMed, 7 syntheses or guidelines pooled it.

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  8. Trial
  9. Development and Validation of a Brief Healthcare Insecurity Scale in a Sample of US Adults Living With and Without HIV.Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research · 2026
    Article
  10. Trends, Disparities, and Outcomes in Time to Treatment Initiation in Patients With Early-Onset Colorectal Cancer.JGH open : an open access journal of gastroenterology and hepatology · 2026
    Article
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37 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

11 authors.

K Robin YabroffSurveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA.
Katherine Reeder-HayesLineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
Jingxuan ZhaoSurveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA.
Michael T HalpernDivision of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA.
Ana Maria LopezSidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA.
Leon Bernal-MizrachiWinship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA.
Anderson B CollierChildren's Cancer Center, The University of Mississippi Medical Center, Jackson, MS, USA.
Joan NeunerMedical College of Wisconsin, Milwaukee, WI, USA.
Jonathan PhillipsAmerican Society of Clinical Oncology, Alexandria, VA, USA.
William BlackstockWake Forest School of Medicine, Winston-Salem, NC, USA.
Manali PatelStanford University School of Medicine, Stanford, CA, USA.

Funding

Reducing Disparities in End of Life Cancer CareK23MD013474 · NIMHD · STANFORD UNIVERSITY · PI PATEL, MANALI I · 2018 to 2020
$502k
NIMHD NIH HHS K23 MD013474
6 · The paper itself

Abstract

backgroundLack of health insurance coverage is associated with poor access and receipt of cancer care and survival in the United States. Disruptions in coverage are common among low-income populations, but little is known about associations of disruptions with cancer care, including prevention, screening, and treatment, as well as outcomes of stage at diagnosis and survival.

methodsWe conducted a systematic review of studies of health insurance coverage disruptions and cancer care and outcomes published between 1980 and 2019. We used the PubMed, EMBASE, Scopus, and CINAHL databases and identified 29 observational studies. Study characteristics and key findings were abstracted and synthesized qualitatively.

resultsStudies evaluated associations between coverage disruptions and prevention or screening (31.0%), treatment (13.8%), end-of-life care (10.3%), stage at diagnosis (44.8%), and survival (20.7%). Coverage disruptions ranged from 4.3% to 32.8% of patients age-eligible for breast, cervical, or colorectal cancer screening. Between 22.1% and 59.5% of patients with Medicaid gained coverage only at or after cancer diagnosis. Coverage disruptions were consistently statistically significantly associated with lower receipt of prevention, screening, and treatment. Among patients with cancer, those with Medicaid disruptions were statistically significantly more likely to have advanced stage (odds ratios = 1.2-3.8) and worse survival (hazard ratios = 1.28-2.43) than patients without disruptions.

conclusionsHealth insurance coverage disruptions are common and adversely associated with receipt of cancer care and survival. Improved data infrastructure and quasi-experimental study designs will be important for evaluating the associations of federal and state policies on coverage disruptions and care and outcomes.

Indexed as

Early Detection of CancerHealth Services AccessibilityHumansInsurance CoverageInsurance, HealthMedicaidMedically UninsuredNeoplasmsObservational Studies as TopicPatient Protection and Affordable Care ActPovertyPublicationsUnited States

Identifiers

PMID32337585
PMCPMC7357319

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.