Expanding Access to Care Could Improve Follicular Lymphoma Outcomes

Privately-insured individuals diagnosed with follicular lymphoma may experience improved survival outcomes compared with those who have no insurance or Medicaid, according to study results published in the journal Blood.

In turn, the researchers recommended to expand access to care through insurance. “Health care policy should be based on evidence, and, for patients with (follicular lymphoma), improving access to care for those who are unable to afford private insurance has the potential to substantially improve outcomes,” they added.

According to the study, it is estimated that approximately 14,000 individuals are diagnosed with follicular lymphoma — the second most common type of non-Hodgkin lymphoma – each year, and unfortunately relapse occurs in up to 20 percent of those within the first two years of first-line treatment.

With what can be a poor prognosis, diagnostics and treatment may also depend on insurance status. “For patients with (follicular lymphoma), lower neighborhood socioeconomic status is associated with substantially poorer survival, suggesting access to care plays an important role in outcomes,” the researchers wrote.

“The social determinants of (follicular lymphoma) prognosis remain unclear and literature on the relationship between access to care and (follicular lymphoma) outcomes is scarce,” they added.

Therefore, the researchers used the National Cancer Database to evaluate over 43,000 patients with follicular lymphoma diagnosed between 2004 and 2014 to examine the relationship between insurance status and overall survival.

Patients were divided by age, which was segmented at 65 years, and insurance status (private insurance, no insurance, Medicaid and Medicare.

Overall, 47 percent of patients had private insurance, 3 percent were uninsured, 4 percent had Medicaid and 46 percent had Medicate.

Through 2014, more than 11,000 patients in the study died.

Patients aged 65 or younger who were uninsured or those who had Medicaid or Medicare demonstrated worse survival rates compared with those who had private insurance. Similarly, those aged 65 and older with Medicare has significantly worse outcomes than the privately-insured.

Patients who were uninsured or had Medicaid typically reported with poorer socioeconomic status, advanced-stage disease, B symptoms (fever, night sweats and weight loss) and multiple comorbidities — all of which could also contribute to survival differences among groups. The researchers noted that these associations persisted when they controlled for known and available sociodemographic and prognostic factors.

“The findings of the study indicate that improving access to affordable, quality healthcare may reduce disparities in survival for those currently lacking coverage,” the researchers wrote.

Lastly, the researchers warranted for more research to be conducted in this area to address any disparities regarding insurance status and follicular lymphoma outcomes.

“Further research on prognosis for (follicular lymphoma) should examine the impact of public policy, such as the passage of the Affordable Care Act, on (follicular lymphoma) outcomes, as well as examine other factors that influence access to care, such as individual-level socioeconomic status, regular primary care visits, access to prescription medications and care affordability,” they added.