Private Insurance Improves Survival of Patients with Stage III/IV Small Cell Lung Cancer within the National Cancer Database

Background: The overall survival for small cell lung cancer (SCLC) patients at 5 years is only 5% to 10%, and improvements in treatment have proved to be unsatisfactory in prolonging SCLC survival. One of the challenges in improving cancer survival is identifying health disparities. In this study, we determined how disparities in payer status affected SCLC patient survival by analyzing data from the National Cancer Data Base (NCDB) between 1998 and 2011. Methods: We evaluated a cohort of 71,724 patients ages 18-65 diagnosed with stage III or IV SCLC who had not undergone surgery or hormonal therapy registered in the NCDB. Overall survival (OS) was the outcome variable, and payer status was the primary predictor variable. Multivariate Cox regression was used to investigate the effect of payer status on OS while adjusting for other factors. Results: The majority of patients diagnosed at stage III-IV had private insurance (57.93%), while 17.75%, 14.69% and 9.64% of patients had Medicare, Medicaid or were uninsured, respectively. Multivariate Cox regression analysis revealed a statistically significant relationship between payer status and overall survival when controlling for other variables. Uninsured, Medicaid, and Medicare patients were found to have a higher risk of death from SCLC compared to privately insured patients (p<.0001). The adjusted median OS of privately insured, uninsured, Medicare, and Medicaid patients was 10.32, 8.97, 9.00, and 9.00 months, respectively. Conclusions: Payer status proved to be a significant predictor of overall survival for SCLC, which remained true after adjusting for the other study variables. Uninsured, Medicaid, and Medicare patients had higher mortality compared to privately insured patients. Further study is needed to investigate the mechanism of payer status on survival of SCLC.