Impact of the COVID-19 pandemic on insurance transitions among commercially insured cancer patients in Washington state

6552 Background: Insurance transitions following cancer diagnosis can disrupt care and impact outcomes. The COVID-19 pandemic impacted employment for millions of Americans, threatening their ability to maintain insurance. Using a large database linking commercial insurance to cancer registry records, we evaluated insurance transitions among newly diagnosed cancer patients in the pre- and post-COVID periods. Methods: We linked Western Washington SEER cancer registry records and enrollment records from two commercial insurers covering 3 million persons and Medicaid in Washington State. Eligible persons were ages 18-63 and commercially insured in the 12 months prior to their first cancer diagnosis. Post-diagnosis follow-up periods were stratified into pre-COVID (January 2017 – February 2020) and post-COVID (March 2020 - December 2020). We created logistic regression models to look at factors associated with (1) disenrollment for any reason and (2) transition to Medicaid, accounting for age, sex, race, year of diagnosis, cancer site, AJCC stage, comorbidities, and Area Deprivation Index (ADI), and diagnosis during the pandemic. Results: Among 5,458 newly diagnosed solid tumor patients enrolled in commercial plans pre-COVID, 16.9% disenrolled for any reason over 12 months following diagnosis. Among disenrollees, 10.0% transitioned to Medicaid. Patients with Lung, Oral, and Myeloma cancers had the highest disenrollments (21.2%, 21.0%, and 19.3% respectively). Among the 1,224 diagnosed post-COVID, 9.7% disenrolled for any reason. Among those who disenrolled, 21.0% enrolled in Medicaid. Patients with Leukemia, Melanoma, Oral, and Gynecologic cancers had the highest disenrollments (23.3%, 14.5%, 13.6%, and 13.6% respectively). In logistic regression, persons diagnosed after the pandemic were less likely to disenroll compared to the pre-pandemic period (Table). Transitions to Medicaid was not greater post-Pandemic. Advanced stage, comorbidity, and living in high ADI regions were significantly associated with transitioning to Medicaid. Conclusions: Newly diagnosed cancer patients with commercial insurance during the COVID-19 pandemic were substantially less likely to disenroll than those diagnosed before the pandemic. The findings may reflect pandemic-related preferences for job stability during a time of personal and societal crisis. [Table: see text]