Impact of Comprehensive Health Insurance on Quality of Life in Low-Income Hispanic Men with Prostate Cancer

Allen Enrique D Siapno; Thomas W Gaither; Megha D Tandel; Lorna Kwan; Ying-Ying Meng; Sarah E Connor; Sally L Maliski; Arlene Fink; Sheba George; Mark S Litwin

doi:10.1016/j.urology.2022.11.001

Impact of Comprehensive Health Insurance on Quality of Life in Low-Income Hispanic Men with Prostate Cancer

Urology. 2023 Feb:172:89-96. doi: 10.1016/j.urology.2022.11.001. Epub 2022 Nov 16.

Authors

Affiliations

¹ Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA. Electronic address: asiapno@mednet.ucla.edu.
² Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA.
³ Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, CA.
⁴ Center for Health Policy Research, University of California, Los Angeles, CA.
⁵ School of Nursing, University of Kansas, Lawrence, KS.
⁶ Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA; Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA.
⁷ Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, CA; Department of Preventive and Social Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA.

PMID: 36400270
DOI: 10.1016/j.urology.2022.11.001

Abstract

Objective: To evaluate the effect of the transition from IMPACT, a disease-focused treatment program, to comprehensive health insurance under Medicaid through the Affordable Care Act (ACA) on general and prostate cancer-specific quality of life (QoL) on a cohort of previously uninsured low-income men. We hypothesize that general QoL would improve and prostate cancer-specific QoL would remain the same after the transition to comprehensive health insurance.

Methods: We assessed and compared general QoL using the RAND SF-12v2™ (12-Item Short Form Survey, version 2) and prostate cancer-specific QoL using the UCLA PCI (Prostate Cancer Index) one year before, at, and one year after the transition between 30 men who transitioned to comprehensive insurance (newly insured/Medicaid group) and 54 men who remained in the prostate cancer program (uninsured/IMPACT group). We assessed the independent effects of Medicaid coverage on QoL outcomes using repeated-measures regression.

Results: Our cohort was composed primarily of Hispanic men (82%). At transition, patient demographics and clinical characteristics were similar between the groups. General and prostate cancer-specific QoL did not differ between the groups and remained stable over time, Radical prostatectomy as primary treatment and shorter time since treatment were associated with worse urinary and sexual function across both groups and over all three time points.

Conclusion: Those who transitioned to full-scope insurance and those who remained in the free prostate cancer-focused treatment program had stable general and prostate cancer-specific QoL. High-touch navigation aspects of a disease-focused program may have contributed to stability in outcomes.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Hispanic or Latino
Humans
Insurance Coverage
Insurance, Health
Insurance, Major Medical
Male
Patient Protection and Affordable Care Act
Percutaneous Coronary Intervention*
Prostatic Neoplasms* / surgery
Quality of Life
United States