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Study finds link between poverty, cancer deaths

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Contributed by: Kevin Hamm/YourHub.com on 8/15/2008

Lack of insurance leads to later diagnosis, less than state-of-the-art care

People who live in poverty are more likely to die after being diagnosed with cancer, according to a study led by Dr. Tim Byers, director of the University of Colorado Cancer Center in Aurora.

Poor people often have no health insurance and are diagnosed later than others, Byers said, leading to an increased mortality rate. While cancer death rates are declining in the overall population due to identifying the disease early in patients and treating it, that's not the case with the poor. Cultural and biological factors play a part in cancer deaths, he said, but they're not the main culprits.

"The biggest factor by far is poverty and lack of access to preventive services and treatment services," he said.

That lack of access is largely due to a lack of insurance, Byers said, and even if someone does get diagnosed, the cost of state-of-the-art treatment is often outside of their means.

"Without health insurance you can't afford treatment A, but you can afford treatment C, but that will probably shorten your life," he said.

According to a March study by Families USA and co-released by the Colorado Consumer Health Initiative, more than 500,000 Coloradans between the ages of 25 and 64 didn't have health insurance in 2006; across the country, the number is 47 million. The group also estimates that 2,100 Coloradans died in 2006 due to a lack of health insurance. More recent studies suggest the number of uninsured in Colorado could be closer to 800,000.

Colorado has a higher-than-average number of uninsured people, said Denise de Percin, executive director of the Colorado Consumer Health Initiative, and that number is rising. Many others are underinsured. For people struggling to make ends meet, health care is only one of a number of things they have to juggle - putting food on the table and paying the rent and heating bills often take priority, she said.

"They're constantly trading off and it never all comes together at the end of the month," de Percin said. "Even if you get a diagnosis, what happens then? Who's going to pay for it?"

Without insurance, these people often rely on community clinics for their care - the "safety net" health care system - and while they generally do a good job of providing care, Byers said, they're underfunded and overburdened.

"Clearly they're not reaching everybody, and they don't have the resources to reach everybody," de Percin said. "They're overloaded when you think about the expense of treating cancer and the kind of time it takes."

"There's a safety net, but the safety net isn't sufficient for (the number) of people who need to use it," de Percin said.

As the president and CEO of Metro Community Provider Network (MCPN), David Myers is responsible for part of that safety net. MCPN runs 12 clinics around the metro area - including three in Aurora - and focuses on providing health care to the uninsured.

He said MCPN currently has upwards of 400 cancer patients in their system awaiting treatment, and they do cancer screenings for several thousand patients a year. MCPN is limited in the amount of treatment they can offer cancer patients and relies on partnerships with doctors in private practice, but those partnerships can handle only a small number of patients.

"I can say quite confidently that the vast majority of patients that are uninsured do not get the treatment that they need for cancer," Myers said.

John Reid is the vice president of development for MCPN. He said the doctors they have partnerships with are "great community-minded physicians who want to help, but they can only do so much," and that leads to hard choices.

"You have to preserve a balancing act," he said. "Which patient this month can we refer to that physician?"

Reid said they're starting to see a lot more of the "working poor" in their clinics. As the economy struggles, small businesses are cutting health insurance leaving many of these workers without coverage, he said.

De Percin is seeing something similar happening in bigger companies, too. She's seen an erosion of employer-sponsored insurance as health care costs spiral out of control. As employers try to keep up with premiums they're being charged by insurers, they raise co-pays or limit coverage on the plans they offer to employees. Often the coverage employees are left with still leaves them exposed if something happens.

"Even those with coverage don't have adequate coverage," she said, noting that half of all bankruptcies are driven by medical costs, and 70 percent of those people have health insurance. "It's affecting the middle class and that's often when issues get attention."

Myers agrees, and said it's been something of a mantra for these safety net providers that change needs to happen, but it will happen only when the pain is more widespread: "Why is it so slow? It doesn't hurt enough people yet."

He said he sees signs that change might be coming. He notes health care is becoming an important issue in this year's election and that people are talking about it and raising awareness.

"For so many years it was not the passionate issue for a lot of policy-makers," he said. "It now is becoming that. I hope that momentum continues."

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