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Epidemiology and Population Studies

Delays in Cancer Diagnosis in Underinsured Young Adults and Older Adolescents

^aBaylor College of Medicine, Houston, Texas, USA; ^bUniversity of Rochester, Rochester, New York, USA; ^cUniversity of Texas School of Public Health, Houston, Texas, USA; ^dUniversity of Texas M.D. Anderson Cancer Center, Houston, Texas, USA; ^eChildren's Oncology Group, Arcadia, California, USA

Key Words. Cancer • Diagnosis • Health insurance • Health services research • Adolescents

Correspondence: Sean Martin, M.D., University of Colorado Health Sciences Center, 7370 East Florida Avenue #1009, Denver, Colorado 80231, USA. Telephone: 775-771-0201; Fax: 541-385-6341; e-mail: Sean.Martin{at}uchsc.edu

Background. In the U.S., adolescents and young adults diagnosed with cancer have had less survival improvement than older or younger patients, a deficit that may be a result of delays in diagnosis in an age group with the lowest rates of health insurance.

Methods. The relationship between health insurance status and the time from the onset of first cancer-specific symptom or sign to definitive diagnosis (lagtime) was retrospectively compared with other sociodemographic factors in newly diagnosed cancer patients aged 15–29 years who were evaluated between June 2001 and June 2003. Data on 270 patients with the six most common cancer types in this cohort (leukemia, Hodgkin's and non-Hodgkin's lymphoma, sarcoma, brain tumors, thyroid cancer) were retrospectively collected in 2004.

Results. Lagtimes were evaluable in 235 (88%) patients. In multivariate analysis, the type of cancer and health insurance were significantly associated with lagtime, whereas race/ethnicity, age, gender, marital status, and surrogate measures of socioeconomic status were not. The mean lagtime in patients with public or no health insurance was 13.1 weeks longer than in patients with private health insurance, and longer in four of six evaluable histology-specific types of cancer. In cancers evaluable for stage at diagnosis, advanced stage was associated with longer lagtimes.

Conclusion. In the U.S., older adolescents and young adults with cancer are likely to have a delay in diagnosis because of inadequate health insurance and consequently present with a more advanced stage of disease.

Disclosure of potential conflicts of interest is found at the end of this article.

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