Patients with Medicaid or no insurance may have smaller added benefits from experimental therapies for the treatment of cancer compared with standard treatments in clinical trials, according to a study published on JAMA Network Open.

The objective of the study was to examine whether positive treatment effects in cancer randomized clinical trials apply to specific demographic or insurance subgroups. A cohort study of pooled patient-level data from 10,804 patients in SWOG Cancer Research Network clinical treatment trials were analyzed. Patients were enrolled from 1984 to 2012 with a maximum follow-up of 5 years.

Interaction tests were used to assess whether hazard ratios (HRs) for death comparing standard group versus experimental group treatments were associated with age, race/ethnicity, sex, or insurance status among patients younger than 65 years in multivariable Cox regression frailty models. Progression-free survival (PFS) or relapse-free survival (RFS) were also examined, with data analyses conducted from August 2019 to February 2020.

Nineteen trials were conducted with the 10,804 patients who reported superior overall survival (OS) randomized to experimental treatments. The patients were predominantly younger than 65 years and female, with 11.4% being African American and 5.7% being Hispanic. Evidence of added survival benefits associated with receipt of experimental therapy for all groups was present, except for patients with Medicaid or no insurance compared with those with private insurance.

Experimental treatment was associated with reduced added OS benefits in patients 65 years and older compared with patients younger than 65 years, although both older and younger patients appeared to strongly benefit from receipt of experimental treatment. The PFS or RFS HRs did not differ by age, sex, or race/ethnicity but differed between patients with Medicaid or no insurance versus private insurance.

The study authors concluded that a better understanding of the quality of survivorship care that patients with suboptimal insurance receive, including supportive care and posttreatment care, could help establish how external factors may affect outcomes for these patients.

Unger JM, Blanke CD, LeBlanc M, et al. Association of Patient Demographic Characteristics and Insurance Status with Survival in Cancer Randomized Clinical Trials With Positive Findings. JAMA Netw Open. 2020;3(4):e203842. doi:10.1001/jamanetworkopen.2020.3842