Interaction between race and insurance coverage for gastroenteropancreatic neuroendocrine tumor outcomes

DO, MPH, MLS Veronica E. NKIE,; Akinola, MD K. Kerrick; MS, PhD Chandler McLeod,; Rose, MD, MAS J. Bart; MD, FACS Ryan C. Fields,; MD, MPH, PhD, FACS Timothy M. Pawlik,; MD, FACS George Poultsides,; MD, FACS Clifford S. Cho,; MD, FACS Sharon Weber,; MD, FACS Kamran Idrees,; MD, FACS Flavio G. Rocha,; MD, FACS Shishir K. Maithel,; MD, MSPH Gillis Andrea

doi:10.1530/endoabs.108.C45

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Endocrine Abstracts (2024) 108 C45 | DOI: 10.1530/endoabs.108.C45

NANETS2024 17th Annual Multidisciplinary NET Medical Symposium NANETS 2024 Clinical - Surgery/Applied Pathology (9 abstracts)

Interaction between race and insurance coverage for gastroenteropancreatic neuroendocrine tumor outcomes

Veronica E. NKIE, DO, MPH, MLS¹, K. Kerrick Akinola, MD², Chandler McLeod, MS, PhD², J. Bart Rose, MD, MAS², Ryan C. Fields, MD, FACS³, Timothy M. Pawlik, MD, MPH, PhD, FACS⁴, George Poultsides, MD, FACS⁵, Clifford S. Cho, MD, FACS⁶, Sharon Weber, MD, FACS⁷, Kamran Idrees, MD, FACS⁸, Flavio G. Rocha, MD, FACS⁹, Shishir K. Maithel, MD, FACS², Gillis Andrea MD & MSPH²

Author affiliations

¹Madigan Army Medical Center, Transitional, Joint Base Lewis-McChord; ²University of Alabama at Birmingham, General Surgery, Birmingham, AL; ³Division of Surgical Oncology, Washington University, St Louis, MO; ⁴Division of Surgical Oncology, Ohio State, Columbus, OH; ⁵Division of Surgical Oncology, Stanford University, Stanford, CA; ⁶Department of Surgery, University of Michigan, Ann Arbor, MI; ⁷Division of Surgical Oncology, University of Wisconsin, Madison, WI; ⁸Division of Surgical Oncology, Vanderbilt University, Nashville, TN; ⁹Division of Surgical Oncology, Knight Cancer Institute, Oregon Health and Science University

Background: While the incidence of common solid tumors has decreased over the last few decades, that of Gastroenteropancreatic Neuroendocrine tumors (GEP-NETs) has steadily risen. Disparities in access and outcomes from GEP-NETs are described for minorities and those with low socioeconomic status. Health insurance is the primary gateway to healthcare access in the United States, and significantly affects patient outcomes. We aim to study the differential impact of the lack of health insurance by race on survival of patients with GEP-NETs.

Methods: Using the US Neuroendocrine Tumor Study Group (USNETSG) database of patients with surgically resected neuroendocrine tumors, we performed a retrospective cohort study of adult patients recently diagnosed with GEP-NETs (2005-2016). Health insurance categories consisted of Uninsured/Unknown (UI), Government Insurance (GI), and Private Insurance (PI) patients. We performed univariate and multivariate Cox proportional hazard (Cox PH) analyses to evaluate the impact of health insurance on progression-free (PFS), recurrence-free (RFS) and overall survival (OS), adjusting for patient and tumor-specific characteristics. We also performed a stratified multivariate analysis by Black and White race.

Results: We identified 1605 patients for our analysis. Mean age was 57.2 (SD 13.48). 225 patients (14%) identified as Black and 1,283 (80%) identified as White. Predominant tumor location was the foregut (83%; Whites 67% vs Blacks 44%) and midgut (17%; Blacks 37% vs Whites 26%). Black had higher incidences of hypertension (67% vs 48%) and diabetes (28% vs 19%); (P < 0.001)979 patients (63%) were PIP, 556 GIP (29%), and 70 UIP (8.6%). Univariate CoxPH for overall survival (OS) showed that compared to PIP, UIP [HR =2.99 (1.97, 4.53, P < 0.001)] and GIP had worse OS [HR=1.53 (1.18, 1.99), P = 0.001]. Multivariate CoxPH analysis results showed UIP had a worse OS: [HR=2.52 (1.03, 6.20), P = 0.044]; while GIP OS was not significantly different from PIP: [HR=0.80 (0.49, 1.31), P = 0.37]. When stratified by race, White UIP patients had worse OS than White PIP [HR=3.16 (1.44, 6.92), P < 0.01] but Black UIP patients were not significantly different in survival from Black PIP [HR=6.12 (0.62, 60.96) P = 0.12]. There were no significant differences in PFS or RFS by insurance status.

Conclusions: Health insurance is an important predictor of overall survival of GEP NETs. While there was no demonstrable difference in GEP-NET OS when stratifying for race, uninsured patients demonstrated worse overall survival compared to patients with government or private insurance.

ABSTRACT ID28686