Ovarian cancer: an institutional review of patterns of care, health insurance and prognosis

Balli, S; Fey, M.F; Hänggi, W; Zwahlen, D; Berclaz, G; Dreher, E; Aebi, S

« Previous Next »European Journal of Cancer
Volume 36, Issue 16 , Pages 2061-2068, October 2000

Ovarian cancer:

an institutional review of patterns of care, health insurance and prognosis

S Balli
- Institute of Medical Oncology, University of Bern, Inselspital, CH-3010 Bern, Switzerland
M.F Fey
- Institute of Medical Oncology, University of Bern, Inselspital, CH-3010 Bern, Switzerland
W Hänggi
- Department of Gynaecology and Obstetrics, University of Bern, Inselspital, CH-3010 Bern, Switzerland
D Zwahlen
- Institute of Medical Oncology, University of Bern, Inselspital, CH-3010 Bern, Switzerland
G Berclaz
- Department of Gynaecology and Obstetrics, University of Bern, Inselspital, CH-3010 Bern, Switzerland
E Dreher
- Department of Gynaecology and Obstetrics, University of Bern, Inselspital, CH-3010 Bern, Switzerland
S Aebi
- Institute of Medical Oncology, University of Bern, Inselspital, CH-3010 Bern, Switzerland
- Corresponding author. Tel.: +41-31-632-4114; fax: +41-31-382-1237

Received 17 February 2000; received in revised form 10 May 2000; accepted 29 June 2000.

Abstract

The purpose of this study was to investigate the prognostic importance of the health insurance status in 145 consecutive patients with ovarian cancer diagnosed between 1984 and 1996. All patients had basic (Type III) insurance to cover outpatient treatment and hospital expenses for a per diem flat fee; some patients had one of two types of supplemental private insurance (Type I and Type II) to cover the treatment by physicians of their choice and fee-for-service hospital treatment. The prognostic impact of health insurance was evaluated by multivariate statistical methods. The median follow-up was 81.9 months (range: 21–181); the 5-year probability of survival was 72% (standard error of the mean (SEM) 9.8%) for stage I, 53% (SEM 16.2%) for stage II, 17% (SEM 5.9%) for stage III and 11% (SEM 5.5%) for stage IV cancer. Age, stage, histological grade and debulking surgery were independent predictors of survival in multivariate proportional hazards regression analysis. Patients with private insurance were younger and received more chemotherapy than patients with basic insurance. In multivariate analysis, insurance was an independent predictor of survival: patients with Type II insurance had a hazard ratio of 2.31 (95% confidence interval (CI): 1.05–5.04), and patients with Type III insurance had a hazard ratio of 3.30 (95% CI 1.52–7.17) compared with the reference group of Type I insured patients. Health insurance status was an independent predictor of survival in ovarian cancer. Research is needed to devise strategies to improve the medical care of patients with basic insurance.

Keywords: Ovarian neoplasms, Insurance, Health, Prognosis, Factor, Age