ArticleTechnical innovations & patient support in radiation oncology2021
The association of health insurance with the survival of cancer patients with brain metastases at diagnosis.
Article in Technical innovations & patient support in radiation oncology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.
What it found
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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.
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.
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Who cites it
3 citing papers in PubMed, 1 synthesis or guideline pooled it, 8 citations in OpenAlex.
- Association of insurance status among cancer patients and survival outcomes: a systematic review and meta-analysis.International journal for equity in health · 2025Pooled it
- Utilization of cancer-directed surgical therapy in Medicaid patients with cancer: comparison between low/intermediate/high-risk surgeries.Cancer causes & control : CCC · 2025Article
- Medicaid expansion is associated with increased 1-year survival for primary malignant brain tumors.Neuro-oncology advancesArticle
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Authors and funding
3 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSynchronous brain metastases (SBMs) are a presentation of stage IV cancers with limited treatment options. This study examines the association between health insurance status and overall survival (OS) of patients with SBMs using the National Cancer Database (NCBD).
methodsWe queried the NCDB for patients with SBMs from 2010 to 2015. Included cases were from seven primary cancers. Patients were grouped based on their insurance status. We assessed the association of insurance with OS using a Cox proportional hazards model adjusted for age at diagnosis, sex, race, education level, income level, residential area, treatment facility type, Charlson-Deyo comorbidity status, year of diagnosis, primary tumor type, and receipt of chemotherapy, radiation therapy (RT), immunotherapy, and primary site surgery.
resultsOf 97,659 patients included, those who had Medicaid, Medicare, or without health insurance were less likely to receive brain RT, chemotherapy, and/or surgery of the primary cancer site compared to privately insured patients. In multivariable COX analysis, patients with Medicare (HR = 1.11, 95% CI: 1.09-1.14, P < 0.001), Medicaid (HR = 1.11, 95% CI: 1.09-1.13, P < 0.001), or no insurance (HR = 1.18, 95% CI: 1.14-1.22, P < 0.001) were associated with decreased OS compared to private insurance.
conclusionAfter retrospective analysis, Medicaid, Medicare, and no insurance were all associated with worse OS compared to private insurance. Future studies can focus on determining the factors associated with insurance status and factors contributing to improved OS stratified by insurance status.
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