Impact of county financial assistance on cancer treatment and survival among uninsured patients.

[BACKGROUND] Texas has the largest uninsured population in the country. To cover medical costs of uninsured patients, multiple counties offer Financial Assistance Programs (FAPs). The association of these programs with access to cancer treatment and survival has not been studied.

[METHODS] Population-based Texas Cancer Registry was used to include uninsured patients aged 18 to 64 years and diagnosed with liver, lung, or pancreatic cancer from 2017 to 2021. County FAP status was ascertained from official county or county hospital websites. Multivariable binary logistic regression analyses were used to determine the adjusted odds of receipt of any cancer treatment (surgery, chemotherapy, or radiation). Subsample analyses were performed for patients with non-metastatic cancer and residents of metropolitan areas. Multivariable Cox Proportional Hazards analyses were used for survival analysis.

[RESULTS] Among 5,477 uninsured patients, 47.7% were reported to have received cancer treatment. On multivariable analysis, living in a county that offered (vs. did not offer) FAPs was associated with 1.49 higher odds of receiving cancer treatment (95%CI: 1.28-1.73). Survival analysis indicated that the Hazards of death were 44% to 55% lower for patients who received cancer treatment and lived in FAP counties (vs. did not receive cancer treatment and did not live in FAP Counties).

[RELEVANCE] For uninsured patients with cancer, residence in a county that offers financial assistance was associated with significantly increased odds of receiving treatment and significantly lower hazards of death. These findings provide evidence for policy interventions that may improve cancer care and outcomes for uninsured patients.