Medical Insurance and Hematological Malignancies in a Rural State: A Comparative Survival Analysis

Introduction The high cost and complexity of cancer care create substantial financial burdens for patients. We examined the relationship between insurance coverage, treatment patterns, and survival outcomes among adults with hematologic malignancies. Methods We queried an institutional cancer registry for adults (≥18 years) with histologically confirmed acute lymphocytic leukemia, acute myeloid leukemia, chronic lymphocytic leukemia, chronic myelogenous leukemia, multiple myeloma, or non-Hodgkin lymphoma treated between 2015 and 2022. Sociodemographic factors, comorbidities, behavioral factors, treatment modality, disease status, and survival were analyzed. Survival differences by insurance were assessed using log-rank testing and univariable and multivariable Cox proportional-hazards models. Results Among 2,516 patients (mean age 62.3 years; 55.7% male; 78.1% White), most had Medicare (50.5%) or private insurance (39.6%). Survival differed significantly by insurance ( P < .001). Compared to private insurance, higher mortality risk was observed among uninsured (Hazard Ratio (HR) = 1.96, P = .008), Medicaid (HR = 1.75, P < .001), and Medicare patients (HR = 1.26, P = .017). Higher mortality was also associated with not receiving stem cell transplantation. Lower mortality was observed among patients who did not receive chemotherapy or palliation, reported current alcohol use, or had a positive family history. Conclusion Insurance status significantly influenced survival. Uninsured and publicly insured patients were most vulnerable, highlighting the need for policy reforms for equitable access to high-quality cancer care.