Cancer’s grim calculus for the young: their insurance status can determine how long they survive

Cancer is becoming increasingly common among young people, with cases slowly and steadily rising every year for the past decade. And what type of insurance adolescents and young adults have affects at what stage of cancer they’re diagnosed and how long they survive.

As researchers who study cancer disparities in young adults, we examine the social and systemic factors that shape who survives a cancer diagnosis. In our recent review of the scientific literature – an analysis that included nearly 470,000 Americans between the ages of 15 and 39 who had been diagnosed with cancer – we found that insurance status is one of the clearest and most consequential factors.

Young people with private health insurance lived longer than those on Medicaid or without insurance. Depending on the cancer, this survival advantage ranged from a modest 8% lower risk of death for lymphoma to a drastic 2 to 2.5 times lower risk of death for melanoma and multiple other cancer types.

Young people are especially at risk

People between the ages of 15 and 39 have especially unstable access to health coverage in the U.S.

Young people in this age group are often finishing school or starting new jobs, including positions that don’t offer benefits. They’re also aging off a parent’s insurance plan, which happens when you turn 26 under current U.S. law. This instability leaves many young people uninsured or underinsured.

The consequences of no or insufficient health coverage go beyond inconvenience. Adolescents and young adults already tend to see smaller improvements in cancer survival over time compared to children and older adults. This gap has puzzled researchers for years.

Insurance instability appears to make this gap even wider.

Insurance shapes the entire cancer experience

Health insurance does far more than cover hospital bills. It determines whether a patient can access a specialist, how quickly treatment begins and whether they are eligible to enroll in a clinical trial.

Strikingly, patients on Medicaid and uninsured patients often had similar cancer outcomes – and both did worse than those with private insurance. This suggests that simply having some form of coverage isn’t enough if that coverage doesn’t actually open doors to quality care.

One underdiscussed consequence of insurance status is access to clinical trials. These studies are often the pathway to the most advanced treatments available. Yet research has found that the type of insurance a young cancer patient has is a significant predictor of whether they enroll in a clinical trial, with higher enrollment rates for those with private insurance.

For cancers such as early stage Hodgkin lymphoma – a cancer more common in young adults – treatment decisions and access to newer approaches can vary significantly based on where and how a patient receives care, which is often tied to their insurance status.

Clarifying cause and effect

The body of research we analyzed primarily tracked patterns in existing data rather than through controlled experiments. That makes it difficult to say with certainty that insurance status directly causes differences in survival.

However, the pattern we observed was consistent across many studies. Moreover, most studies recorded insurance status only at the time of diagnosis, which misses changes that happen during treatment. Patients may lose or gain coverage in the middle of their care.

Future research that tracks insurance continuously throughout treatment, standardizes how coverage is categorized and examines specific cancer types and age subgroups in greater depth could clarify the picture further.

What can be done to help young cancer patients

The good news is that insurance is something society can change. Based on our research, a few key areas stand out.

Expanding coverage could help keep more young cancer patients insured. This might look like policies allowing young adults to stay on a parent’s plan longer, expanding Medicaid and reducing gaps in coverage after diagnosis.

Improving what Medicaid actually covers could make it easier for patients to access top cancer centers. Many doctors and cancer centers limit how many Medicaid patients they see because reimbursement rates are low.

Connecting with financial counselors, patient navigators and care coordinators could help young patients on public insurance or those who lack insurance navigate the system. This support could enable them to get timely access to the right treatments and clinical trials.

Early screening for financial barriers can prompt timely referrals to financial counseling, assistance programs or social work before patients experience treatment delays. Financial support can help patients complete treatment, make their appointments and improve their outcomes.

Rhonda Winegar, Assistant Professor of Nursing, University of Texas at Arlington; Tara Martin, Clinical Assistant Professor of Nursing, University of Texas at Arlington, and Zhaoli Liu, Assistant Professor of Nursing, University of Texas at Arlington

This article is republished from The Conversation under a Creative Commons license. Read the original article.

This story was originally featured on Fortune.com