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The influence of employer-based health insurance and job support on receipt of adjuvant chemotherapy in stage III colorectal cancer.

278 Background: Approximately 15% of the U.S. population lacks health insurance. Adjuvant chemotherapy confers significant survival benefit in stage III colorectal cancer (CRC), yet many patients fail to receive recommended care. We hypothesized that access to employer-based health insurance (EBHI) and other job-related support programs influences receipt of chemotherapy.


METHODS
We performed a population-based survey of patients diagnosed with stage III CRC in the state of Georgia and Metropolitan Detroit SEER catchment areas. The primary outcome was receipt of adjuvant chemotherapy. Patients were queried regarding clinical, sociodemographic, and employment characteristics (EBHI and job support - e.g., sick leave, disability, flexible schedule, unpaid time off). We used χ2 analyses to examine associations between health insurance coverage, job support availability and receipt of chemotherapy, adjusting for other characteristics.


RESULTS
To date, 630 patients have responded (preliminary response rate=56%). 257 (41%) were working for pay at diagnosis, of whom 46% had EBHI and 9% had no insurance at all. Rates of chemotherapy receipt were higher among those with EBHI than those without (97% vs. 90%, P=0.001). 26% with EBHI reported that they kept their job mainly to keep insurance. 79% of those working for pay reported some form of available job support. Rates of chemotherapy receipt were higher among employed respondents with job support compared to those without (97% vs. 85%, P<0.001). Availability of job support was significantly associated with ability to retain employment; 48% of those without support stopped working altogether because of CRC vs. only 11% of those with support (P<0.001).


CONCLUSIONS
Patients with EBHI and job support were significantly more likely to receive recommended adjuvant chemotherapy after surgery for stage III CRC. Further, lack of job-related support for medical illness was significantly associated with loss of employment for patients undergoing treatment for CRC. These findings suggest that employer-based health insurance and job support are important contributors to receipt of recommended cancer care.