AUTHOR=Bourlon Maria T. , Remolina-Bonilla Yuly A. , Acosta-Medina Aldo A. , Saldivar-Oviedo Bruno I. , Perez-Silva Antonio , Martinez-Ibarra Nayeli , Castro-Alonso Francisco Javier , Martín-Aguilar Ana E. , Rivera-Rivera Samuel , Mota-Rivero Fernando , Pérez-Pérez Perla , Díaz-Alvarado María G. , Ruiz-Morales José M. , Campos-Gómez Saúl , Martinez-Cannon Bertha Alejandra , Lam Elaine T. , Sobrevilla-Moreno Nora 

TITLE=Impact of healthcare inequities on survival in Mexican patients with metastatic renal cell carcinoma

JOURNAL=Frontiers in Oncology

VOLUME=Volume 13 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2023.1229016

DOI=10.3389/fonc.2023.1229016

ISSN=2234-943X

ABSTRACT=Introduction: The survival of patients with metastatic renal cell carcinoma (mRCC) has improved dramatically due to novel systemic treatments. However, mRCC mortality continues to rise in Latin America.

Methods: A retrospective, multicenter study of patients diagnosed with mRCC between 2010-2018 in Mexico City was conducted. The aim of the study was to evaluate the impact of healthcare insurance on access to treatment and survival in patients with mRCC.

Results: Among 924 patients, 55.4%, 42.6%, and 1.9% had no insurance (NI), social security, (SS) and private insurance (PI), respectively. De novo metastatic disease was more common in NI patients (70.9%) compared to SS (47.2%) and PI (55.6%) patients (p<0.001). According to IMDC Prognostic Index, 20.2% were classified as favorable, 49% as intermediate, and 30.8% as poor-risk disease. Access to systemic treatment differed by healthcare insurance:  36.1%, 99.5%, and 100% for the NI, SS, and PI patients, respectively (p<0.001). NI patients received fewer lines of treatment, with 24.8% receiving only one line of treatment (p<0.001). Median overall survival (OS) was 13.9 months for NI, 98.9 months for SS, and 147.6 months for NI patients (p<0.001). In multivariate analysis, NI status, brain metastases, sarcomatoid features, bone metastases, no treatment were significantly associated with worse OS. 

Conclusion: OS in mRCC was affected by insurance availability in this resource-limited cohort of Mexican patients. These results underscore the need for effective strategies to achieve equitable healthcare access in an era of effective, yet costly systemic treatments.