Effect of insurance status and distance from treatment center on the overall survival of patients with non-small cell lung caner treated in an academic center

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Background: A large proportion of patients withcancer treated in academic centers do not have insurance and they travel from far distances to get medical care. We have retrospectively analyzed the outcome of 230 patients with non small cell lung caner in our cancer center and evaluated the effect of insurance status and their distances from our center on overall survival. These patients have traveled from many different regional cities to our center since mid-1996 to November 2008. Methods: We have performed a multivariate analysis on 230 patients with all stages of non small cell lung cancer correcting for sex, race, age, comorbidity, stage of cancer, body mass index, histology, chemotherapy, performance status, smoking history, distance from our center and insurance status. The distance ranged from 0.4 to 343 miles with mean of 69 (standard deviation of 71) . Age ranged from 30 to 89 with a mean number of 57 (standard deviation of 10).Insurance status was divided into 3 categories of no insurance, medicaid and with insurance. Chi square test was used to compare the distribution of the stages of lung cancer patients with other categorial variables. The log rank test was used to compare the survival of different categorical variables and Cox proportional regression was used for multivariate analysis of overall survival. Results: There were no statistical significant differences on overall survival considering distance of travel or insurance status.(P value for distance was 0.505 and for insurance it was 0.648). Smokers and patients with a poor performance status (ECOG 3 and 4) had a statiatically significant worse overall survival. (P value for smoking was 0.0036 and p value for ECOG equal or above 4 was <0.0001). Conclusions: The results from our study indicate that travel distance and payer status do not effect overall survival in lung cancer patients at our center.

No significant financial relationships to disclose.