Most Americans under the age of 65 receive health insurance coverage through their employer, or through a parent’s employer. This means that Americans who lose their job also typically lose their health insurance. For people fighting cancer and their family members, losing health insurance coverage can be a devastating blow. In addition, Americans may miss expensive preventative screenings and treatment that may otherwise be fully covered under a typical health insurance plan, such as mammograms and the HPV vaccine.

Disruptions in access to health insurance can cause several problematic outcomes for patients diagnosed with cancer and for people who routinely miss preventative care. According to a study published in the Journal of the National Cancer Institute, uninsured persons were significantly more likely to present with an advanced stage of cancer than people with health insurance. Uninsured cancer patients were also significantly less likely to receive any or all recommended cancer treatment and experienced worse outcomes, including decreased chances of survival.

Because of the out-of-pocket cost of medical tests and treatments without insurance, uninsured people often avoid seeking treatment until cancer symptoms are severe. Advanced cancer is generally more difficult to treat than early-stage cancer, especially if it has metastasized from its location of origin. This alone could cause decreased chances of survival, but when coupled with the fact that some uninsured cancer patients avoid treatment in part or in full due to the cost, odds of survival are significantly impacted.

This situation is true for the chronically uninsured and for those who experience gaps in coverage during job losses or loss in Medicaid coverage. Understanding the potential implications of health insurance status can help doctors to best treat patients, with and without cancer.

Immunotherapy is becoming the standard of care for many cancers, utilizing the body’s own immune system to fight cancer cells. Checkpoint inhibitors, one form of immunotherapy, allow the immune system to find and fight cancerous cells. Cancers of the bladder, breast, cervix, colon, esophagus, head, neck, kidney, blood, liver, lung, prostate and skin can all be treated with various forms of immunotherapy. One type of cancer that has proven very difficult to treat with immunotherapy is brain cancer, especially gliomas (glioblastoma multiforme or GBM). As cancers mutate, they often can become easier for the immune system to recognize with immunotherapy, but this is not the case for gliomas.

A glioma analysis published in the journal Nature looked at 10,200 cases of gliomas and found that immunotherapy is largely ineffective at treating this form of brain cancer. Typically, as a cancer mutates, it loses some resistance to the human immune system, which allows checkpoint inhibitor treatments to expose the cancer. However, even after several mutations, glioma cells still evaded the immune system after checkpoint inhibitor immunotherapy. Researchers believe that several immunosuppressive activities in the brain may help shelter gliomas from the immune system. Further research will be needed to discover how to expose gliomas to more cytotoxic lymphocytes, which are key cells in fighting disease.

This study also showed that the standard chemotherapy treatment for gliomas, temozolomide, becomes less effective if the glioma mutates, making the cancer harder to treat. Temozolomide is largely ineffective on hypermutated gliomas, as is immunotherapy. Ultimately, this analysis explains why gliomas, and especially glioblastomas, are known for their resistance to traditional cancer therapies and provides further insight into the treatment of gliomas with standard and new cancer therapies, paving the way for additional research.