Samuel U Takvorian1,2,3, Arman Oganisian3,4, Ronac Mamtani1,2, Nandita Mitra3,4, Lawrence N Shulman1,2, Justin E Bekelman2,3,5,6, Rachel M Werner3,7,8. 1. Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia. 2. Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania, Philadelphia. 3. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia. 4. Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia. 5. Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia. 6. Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia. 7. Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia. 8. Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania.
Abstract
Importance: The effect of the Patient Protection and Affordable Care Act's Medicaid expansion on cancer care delivery and outcomes is unknown. Patients with cancer are a high-risk group for whom treatment delays are particularly detrimental. Objective: To examine the association between Medicaid expansion and changes in insurance status, stage at diagnosis, and timely treatment among patients with incident breast, colon, and non-small cell lung cancer. Design, Setting, and Participants: This quasi-experimental, difference-in-differences (DID) cross-sectional study included nonelderly adults (aged 40-64 years) with a new diagnosis of invasive breast, colon, or non-small cell lung cancer from January 1, 2011, to December 31, 2016, in the National Cancer Database, a hospital-based registry capturing more than 70% of incident cancer diagnoses in the United States. Data were analyzed from March 8 to August 15, 2019. Exposures: Residence in a state that expanded Medicaid on January 1, 2014. Main Outcomes and Measures: The primary outcomes were insurance status, cancer stage, and timely treatment within 30 and 90 days of diagnosis. Results: A total of 925 543 patients (78.6% women; mean [SD] age, 55.0 [6.5] years; 14.2% black; and 5.7% Hispanic) had a new diagnosis of invasive breast (58.9%), colon (14.6%), or non-small cell lung (26.5%) cancer; 48.3% resided in Medicaid expansion states and 51.7% resided in nonexpansion states. Compared with nonexpansion states, the percentage of uninsured patients decreased more in expansion states (adjusted DID, -0.7 [95% CI, -1.2 to -0.3] percentage points), and the percentage of early-stage cancer diagnoses rose more in expansion states (adjusted DID, 0.8 [95% CI, 0.3 to 1.2] percentage points). Among the 848 329 patients who underwent cancer-directed therapy within 365 days of diagnosis, the percentage treated within 30 days declined from 52.7% before to 48.0% after expansion in expansion states (difference, -4.7 [95% CI, -5.1 to -4.5] percentage points). In nonexpansion states, this percentage declined from 56.9% to 51.5% (difference, -5.4 [95% CI, -5.6 to -5.1] percentage points), yielding no statistically significant DID in timely treatment associated with Medicaid expansion (adjusted DID, 0.6 [95% CI, -0.2 to 1.4] percentage points). Conclusions and Relevance: This study found that, among patients with incident breast, colon, and lung cancer, Medicaid expansion was associated with a decreased rate of uninsured patients and increased rate of early-stage cancer diagnosis; no evidence of improvement or decrement in the rate of timely treatment was found. Further research is warranted to understand Medicaid expansion's effect on the treatment patterns and health outcomes of patients with cancer.
Importance: The effect of the Patient Protection and Affordable Care Act's Medicaid expansion on cancer care delivery and outcomes is unknown. Patients with cancer are a high-risk group for whom treatment delays are particularly detrimental. Objective: To examine the association between Medicaid expansion and changes in insurance status, stage at diagnosis, and timely treatment among patients with incident breast, colon, and non-small cell lung cancer. Design, Setting, and Participants: This quasi-experimental, difference-in-differences (DID) cross-sectional study included nonelderly adults (aged 40-64 years) with a new diagnosis of invasive breast, colon, or non-small cell lung cancer from January 1, 2011, to December 31, 2016, in the National Cancer Database, a hospital-based registry capturing more than 70% of incident cancer diagnoses in the United States. Data were analyzed from March 8 to August 15, 2019. Exposures: Residence in a state that expanded Medicaid on January 1, 2014. Main Outcomes and Measures: The primary outcomes were insurance status, cancer stage, and timely treatment within 30 and 90 days of diagnosis. Results: A total of 925 543 patients (78.6% women; mean [SD] age, 55.0 [6.5] years; 14.2% black; and 5.7% Hispanic) had a new diagnosis of invasive breast (58.9%), colon (14.6%), or non-small cell lung (26.5%) cancer; 48.3% resided in Medicaid expansion states and 51.7% resided in nonexpansion states. Compared with nonexpansion states, the percentage of uninsured patients decreased more in expansion states (adjusted DID, -0.7 [95% CI, -1.2 to -0.3] percentage points), and the percentage of early-stage cancer diagnoses rose more in expansion states (adjusted DID, 0.8 [95% CI, 0.3 to 1.2] percentage points). Among the 848 329 patients who underwent cancer-directed therapy within 365 days of diagnosis, the percentage treated within 30 days declined from 52.7% before to 48.0% after expansion in expansion states (difference, -4.7 [95% CI, -5.1 to -4.5] percentage points). In nonexpansion states, this percentage declined from 56.9% to 51.5% (difference, -5.4 [95% CI, -5.6 to -5.1] percentage points), yielding no statistically significant DID in timely treatment associated with Medicaid expansion (adjusted DID, 0.6 [95% CI, -0.2 to 1.4] percentage points). Conclusions and Relevance: This study found that, among patients with incident breast, colon, and lung cancer, Medicaid expansion was associated with a decreased rate of uninsured patients and increased rate of early-stage cancer diagnosis; no evidence of improvement or decrement in the rate of timely treatment was found. Further research is warranted to understand Medicaid expansion's effect on the treatment patterns and health outcomes of patients with cancer.
Authors: Bahaa Kazzi; Fumiko Chino; Brigitte Kazzi; Bhav Jain; Sibo Tian; Joseph A Paguio; J Seth Yao; Vinayak Muralidhar; Brandon A Mahal; Paul L Nguyen; Nina N Sanford; Edward Christopher Dee Journal: Support Care Cancer Date: 2022-07-25 Impact factor: 3.359
Authors: Benjamin B Albright; Dimitrios Nasioudis; Stuart Craig; Haley A Moss; Nawar A Latif; Emily M Ko; Ashley F Haggerty Journal: Am J Obstet Gynecol Date: 2020-08-07 Impact factor: 8.661
Authors: Jessica Y Islam; Veeral Saraiya; Rebecca A Previs; Tomi Akinyemiju Journal: Int J Environ Res Public Health Date: 2021-06-04 Impact factor: 3.390
Authors: Justin M Barnes; Kimberly J Johnson; Eric Adjei Boakye; Lidia Schapira; Tomi Akinyemiju; Eliza M Park; Evan M Graboyes; Nosayaba Osazuwa-Peters Journal: J Natl Cancer Inst Date: 2021-07-14 Impact factor: 11.816
Authors: Zachary A K Frosch; Nicholas Illenberger; Nandita Mitra; Daniel J Boffa; Matthew A Facktor; Heidi Nelson; Bryan E Palis; Justin E Bekelman; Lawrence N Shulman; Samuel U Takvorian Journal: JAMA Netw Open Date: 2021-07-01