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

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.
Competing Interests: MB declares potentially relevant relationships concerning travel grants, advisory boards, consulting fees and honoraria for speaking with Pfizer, Bayer, Bristol Myers Squibb, MSD, Merck, Ipsen, Bayer, EISAI and Novartis. YR-B and FC-A declares potentially relevant relationships concerning travel grants with Bristol Myers Squibb. AM-A declares conflicts of interest concerning travel grants, advisory boards and honoraria for speaking with Pfizer, Novartis, Bayer, Ipsen, Bristol Myers Squibb. SR-R declares potentially relevant relationships for honoraria for speaking with Bayer, Pfizer, Novartis, BMS, MSD, Asofarma, Janssen, Sanofi and Ipsen. PP-P declares conflicts of interest concerning travel grants, advisory boards, consulting fees and honoraria for speaking with Janssen, BMS, Pfizer, Ipsen and Roche. JR-M declares relationships concerning travel grants and advisory boards with Ipsen, Asofarma and Bristol Myers Squibb. SC-G declares conflicts of interest concerning consultant or advisory role for Roche, MSD, Janssen and Bristol-Myers Squibb. EL receives institutional research funding from Arrowhead, BMS, Merck, Pfizer, and Roche. NS-M declares relevant relationships for Advisory boards, honoraria for speaking and Principal Investigator or Subinvestigator in clinical trials with BMS, MSD, Novartis, Pfizer, Janssen, Asofarma, Sanofi, Ipsen. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
(Copyright © 2023 Bourlon, Remolina-Bonilla, Acosta-Medina, Saldivar-Oviedo, Perez-Silva, Martinez-Ibarra, Castro-Alonso, Martín-Aguilar, Rivera-Rivera, Mota-Rivero, Pérez-Pérez, Díaz-Alvarado, Ruiz-Morales, Campos-Gómez, Martinez-Cannon, Lam and Sobrevilla-Moreno.)