Ovarian cancer: an institutional review of patterns of care, health insurance and prognosis

The purpose of this study was to investigate the prognostic importance of t he health insurance status in 145 consecutive patients with ovarian cancer diagnosed between 1984 and 1996. All patients had basic (Type III) insuranc e to cover outpatient treatment and hospital expenses for a per dient flat fee; some patients had one of two types of supplemental private insurance ( Type I and Typo II) to cover the treatment by physicians of their choice an d fee-for-service hospital treatment. The prognostic impact of health insur ance was evaluated by multivariate statistical methods. The median follow-u p was 81.9 months (range: 21-181); the 5;-year probability of survival was 72% (standard error of the mean (SEM) 9.8%) for stage I; 53% (SEM 16.2%) fo r stage II, 17% (SEM 5.9%) for stage III and 11% (SEM 5.5%) for stage IV ca ncer. Age, stage, histological grade and debulking surgery were independent predictors of survival in multivariate proportional hazards regression ana lysis. Patients with private insurance were younger and received more chemo therapy than patients with basic insurance. In multivariate analysis, insur ance was an independent predictor of survival: patients with Type II insura nce had a hazard ratio of 2.31 (95% confidence interval (CI): 1.05-5.04), a nd patients with Type III insurance had a hazard ratio of 3.30 (95% CI 1.52 -7.17) compared with the reference group of Type I insured patients. Health insurance status was an independent predictor of survival in ovarian cance r. Research is needed to devise strategies to improve the medical care of p atients with basic insurance. (C) 2000 Elsevier Science Ltd. All rights res erved.