Wednesday, December 10, 2008

Cancer Report Update

I received today an answer from the American Cancer Society regarding my questions on whether uninsured Americans were included in the recent media report that the rate of specific forms of cancer was indeed decreasing. Here's the "copy and paste" reply I received and I thank the ACS for taking the time to respond to my questions.

Dear James,

Thank you for your patience while we looked into your question concerning the recent Report to the Nation on the Status of Cancer and uninsured cancer patients. The staff in our National Home Office to whom your question was referred notes that you make a great point that cancer incidence rates may not be decreasing among the uninsured segment of the US population. Our staff member advises that the answer to your question is complex ,and provides the following in response:

"Cancer diagnoses are reported to state registries regardless of the health insurance status of the patient, so the statistics include patients who are privately insured, Medicaid and Medicare insured, and the uninsured. (Uninsured patients who are diagnosed with cancer become eligible for Medicaid retroactively at the time of diagnosis.) So technically, yes, uninsured patients are included in cancer statistics. However, the extent to which they are included because they actually receive health care and a diagnosis is the deeper question. The report does not 'account ' for uninsured patients who have cancer, but aren't diagnosed (and therefore are not included in registry data) because they do not have access to health care. We do know that the outcomes for uninsured cancer patients are much worse than those patients who are privately insured, the data for which is included in the study found at the link below."


And so, here's a copy and paste of my response back to the American Cancer Society:


I appreciate greatly the response I received regarding my questions regarding the methodology behind the recent Report to the Nation on the Status of Cancer.. Essentially, if I read your response correctly, I can assume that my original concern that uninsured individuals and their lack of making themselves available to the health care system were not necessarily included in this report and therefore the possibility of a potential higher rate of cancer in terms of diagnoses and treatment within this population could theoretically off set the established, already diagnosed cancer rate and reported decline in the study's actual population.

And so then..I could possibly interpret the recent report as being somewhat flawed in that it did not take into account a full representation of our population. Of course, the fact that there was a decline within the usual cohort of subjects is a cause for further analysis and celebration and so therefore your organization continues to do good work for our country.

My concern is how do we capture this other grouping of the population that unfortunately is sequestered away from appropriate medical evaluation and treatment?

I'm not sure quite honestly as to whether your organization needs to remain non partisan in terms of the vagueries of national domestic political agendas. But I am running for US Senate in 2010 and one of my key interests and foci is procuring an equitable health care system for all of us. And quite honestly, I'm not at all happy with the direction of any domestic health policy initiative that fails to include the full spectrum of all Americans. Obviously, I can play the proverbial "devil's advocate" and appreciate that perhaps the authors of the Report to the Nation inadvertently forgot about this particular subset of the uninsured. Likewise, as a scientist, I can appreciate that perhaps if the study did include this particular strata of subjects then maybe even in that grouping there may still be a decline in cancer rate and so therefore the study and report remains even more relevant. I can't make assumptions however. I have a serious aversion to statistics given the various manipulations of same when used to advance any political agenda.

What I want to know can the ACS help me in developing a logical and viable plan of action in the study, identification and treatment of cancers in ALL American subgroups and what can I do for you to advance your particular agendas? Yes...this is a quid pro quo and I would appreciate discussing both of our futures and initiatives.

-Jim Egnor

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