CORR Insights®: Is There an Association Between Insurance Status and Survival and Treatment of Primary Bone and Extremity Soft-Tissue Sarcomas? A SEER Database Study.

The US healthcare financial system is a complicated maze of government and insurance regulations. Put simply, most veterans and people older than 65 years of age are covered by government-provided insurance. The majority of Americans 64 years of age and younger obtain insurance through their employer either directly or as a family plan. The remainder of the population in the United States qualifies for Medicaid, the Children’s Health Insurance Program (CHIP), purchases insurance through the exchanges (via the Affordable Care Act [ACA]), or is uninsured. To qualify for Medicaid, a family and/or an individual must have a very low income. The income levels and disabilities for qualification vary by state. In the 36 states that have expanded Medicaid by accepting federal dollars for the program, the income level for qualification increases and the number of uninsured people decreases correspondingly. Those that do not qualify for Medicaid and do not have employer-based coverage, or another source of insurance represent the majority of millions of uninsured Americans (27.4 million, in 2017) [3]. In the current study, Smartt and colleagues [8] used data from the Surveillance, Epidemiology, and End Results (SEER) database to investigate cancer-related outcomes of patients with bone or soft-tissue sarcomas stratified by insurance status. This study provides an interesting snapshot into the complicated US healthcare system by focusing on outcomes of these rare diseases [1]. The authors looked at three important clinical outcomes in patients with a bone or soft-tissue sarcoma: (1) Presence of metastasis at the time of diagnosis; (2) rates of limb salvage compared to amputation; and (3) death related to cancer. The authors then correlated those cancer-related outcomes to insurance status and found that a patient with Medicaid who is diagnosed with sarcoma is more likely to present with metastases, have an amputation, and/or die of their disease compared to patients with non-Medicaid insurance. Their findings support those of other cancer-related outcome studies [1, 2].