Impact of Insurance Status on Survival Outcomes in Patients With Metastatic Renal Cell Carcinoma

PURPOSE The impact of insurance status on survival outcomes in patients receiving first-line systemic therapy for metastatic renal cell carcinoma (mRCC) has not been explored. Herein, we aimed to determine whether insurance status affects progression-free survival (PFS) and overall survival (OS) in this setting. METHODS Patients diagnosed with mRCC between 1990 and 2022 from two National Cancer Institute–designated cancer centers with available insurance information were retrospectively identified using institutional databases. Patients were stratified by primary insurance type and secondary insurance status. PFS and OS were estimated by the Kaplan-Meier method and compared on the basis of insurance status using log-rank tests. Univariable and multivariable models were used to examine the impact of insurance status on survival outcomes. RESULTS Of the 645 patients evaluated, 344 (53.3%), 250 (38.8%), and 51 (7.9%) had primary Medicare, private insurance, and Medicaid/no insurance, respectively. Compared with the Medicaid/no insurance group, patients with primary Medicare had significantly better PFS (hazard ratio [HR], 0.698 [95% CI, 0.502 to 0.971], P = .033), whereas patients with private insurance had similar PFS (HR, 1.017 [95% CI, 0.737 to 1.404], P = .917). Having secondary coverage was associated with significantly better PFS, but not OS, compared with primary coverage alone (HR, 0.812 [95% CI, 0.674 to 0.978], P = .028; HR, 1.025 [95% CI, 0.822 to 1.279], P = .824, respectively). Medicare was associated with lower risk of death compared with Medicaid/no insurance (HR, 0.495 [95% CI, 0.336 to 0.730], P < .001), whereas no significant difference in OS between private and Medicaid/no insurance groups was observed (HR, 0.955 [95% CI, 0.660 to 1.382], P = .807). CONCLUSION In patients with mRCC, Medicare was associated with significantly better survival outcomes compared with Medicaid/no insurance and having secondary insurance was associated with better PFS compared with primary insurance alone. These results contribute to understanding cancer-related disparities and provide valuable data for devising solutions to address health care inequities.