Newswise — You have no insurance, and you are diagnosed with a colon and rectal cancer. You may be one of the thousands of patients in the United States who find themselves being taken care of at a “safety net hospital.” These are hospitals that are required to treat all patients regardless of their insurance status or ability to pay. They make up about 15% of hospitals in the United States and are traditionally the “public general” hospitals. How good is your care going to be? In the January issues of Diseases of the Colon & Rectum, researchers from Case Western Reserve University School of Medicine try to answer this question by comparing 350 consecutive patients with colorectal cancer treated at a safety net hospital over a 6-year period and then comparing these to an equal number of colorectal cancer patients treated at a private tertiary care center. The researchers found that patients treated at the safety net hospital were younger than those treated at the tertiary care center. In addition, more blacks and patients with English as a second language and patients with a lower median household income were treated at the safety net hospital. The number of patients who had no insurance or Medicaid was three times higher at the safety net hospital. There was no difference in the proportion of patients who underwent curative cancer resection (83% safety net hospital vs 77% tertiary care center). Final pathologic stage was also similar between hospitals. Interestingly, after similar follow-up periods, the overall survival was slightly better in safety net hospitals, with disease-free survival being similar. In this study, 16% of colorectal cancer patients treated at the safety net hospital had no insurance. As the authors state, under the Patient Protection and Affordable Care Act, although more patients have insurance, the funding decreases for those hospitals who continue to provide care for large numbers of uninsured and Medicaid patients. It is essential to maintain funding to safety net hospitals, so that they can continue to provide high-quality cancer care to those without insurance for various reasons and who may remain so for years to come.

A quote from study author Scott Steele, MD, Chair, Department of Colorectal Surgery, Rupert B. Turnbull, MD Endowed Chair in Colorectal Surgery, Cleveland Clinic, Cleveland, OH, and Professor of Surgery, Case Western Reserve University School of Medicine:  "We were pleasantly surprised to see similar (if not slightly better) oncological outcomes in safety net hospitals, despite the inherent differences.  Importantly, I think it highlights the great work our healthcare providers perform on all patients, without thought of demographic or socioeconomic differences."

Citation: Althans AR, Brady JT, Times ML, Keller DS, Harvey AR, Kelly ME, Patel ND, Steele SR.  Colorectal Cancer Safety Net: Is It Catching Patients Appropriately? Dis Colon Rectum 2018;61:115-123 (January 2018 issue)

A prepublication copy is available upon request. Please email Margaret Abby, Managing Editor, Diseases of the Colon and Rectum, at [email protected]