33697University of South Florida Morsani College of Medicine, Tampa, FL, USA.
Department of Internal Medicine, 7831University of South Florida, Tampa, FL, USA.
Cancer Control. 2022 Jan-Dec;29:10732748211072983. doi: 10.1177/10732748211072983.
There is limited research on screening rates among uninsured cancer survivors. Uninsured cancer survivors are at higher risk of poorer health outcomes than the insured due to limited access to preventative screening for secondary cancers. This study examines the rates of surveillance and screening of uninsured cancer survivors and compares to uninsured patients without a cancer history seen in free clinics.
Data were collected retrospectively from electronic medical records and paper charts of patients from 10 free clinics between January 2016 and December 2018 in the Tampa Bay area. The prevalence of socioeconomic characteristics, cancer diagnoses, and screening practices were compared for cancer survivors and free clinic patients without a history of cancer. Study participants were determined to be eligible for cancer screenings based on the United States Preventive Services Task Force guidelines.
Out of 13 982 uninsured patients frequenting free clinics between 2016 and 2018, 402 (2.9%) had a documented history of cancer. Out of the 285 eligible cancer survivors, 44 (15.4%) had completed age-appropriate colon cancer screening. Among the 170 female cancer survivors, 75 (44.1%) had completed breast cancer screenings, and only 5.9% (59/246) had completed cervical cancer screenings. After adjusting for age, gender, race, salary, employment status, and household size, cancer survivors were more likely to undergo colorectal cancer screening (OR: 3.59, 95% CI: 2.10-6.15) and breast cancer screening (OR: 2.13, 95% CI: 1.30-3.84) than patients without a cancer history. This difference was not seen for cervical cancer screening (OR: 0.99, 95% CI: .62-1.58).
Uninsured cancer survivors frequenting free clinics represent a unique population that is underrepresented in the medical literature. Our results suggest that uninsured survivors use screening services at higher rates when compared to uninsured patients without a reported cancer diagnosis. However, these rates are suboptimal when compared to national screening rates of insured cancer survivors.
针对未参保癌症幸存者的筛查率，相关研究有限。由于无法获得针对继发性癌症的预防筛查，未参保癌症幸存者的健康结局较参保者更差，这一现象较为普遍。本研究旨在调查未参保癌症幸存者的监测和筛查率，并与未参保癌症患者（在免费诊所就诊）进行比较。
本研究从 2016 年 1 月至 2018 年 12 月坦帕湾地区的 10 家免费诊所的电子病历和纸质图表中回顾性收集数据。将癌症幸存者和无癌症病史的免费诊所患者的社会经济特征、癌症诊断和筛查情况进行比较。根据美国预防服务工作组指南，确定研究参与者有资格进行癌症筛查。
在 2016 年至 2018 年间，光顾免费诊所的 13982 名未参保患者中，有 402 人（2.9%）有癌症病史记录。在 285 名符合条件的癌症幸存者中，有 44 人（15.4%）接受了年龄适宜的结肠癌筛查。在 170 名女性癌症幸存者中，有 75 人（44.1%）接受了乳腺癌筛查，而仅有 5.9%（59/246）接受了宫颈癌筛查。在调整年龄、性别、种族、工资、就业状况和家庭规模后，癌症幸存者更有可能接受结直肠癌筛查（OR：3.59，95%CI：2.10-6.15）和乳腺癌筛查（OR：2.13，95%CI：1.30-3.84），而非无癌症病史的患者。但宫颈癌筛查（OR：0.99，95%CI：.62-1.58）则不然。
光顾免费诊所的未参保癌症幸存者代表了一个独特的人群，该人群在医学文献中代表性不足。我们的研究结果表明，与无癌症诊断的未参保患者相比，未参保幸存者的筛查服务使用率更高。但与有保险的癌症幸存者的全国筛查率相比，这些比率仍不理想。
