BACKGROUND: Medicaid expansion under the Affordable Care Act has improved access to screening and treatment for certain cancers. It is unclear how this policy has affected the diagnosis and management of pancreatic cancer. METHODS: Using a quasi-experimental difference-in-differences (DID) approach, we analyzed Medicaid and uninsured patients in the National Cancer Data Base during two time periods: pre-expansion (2011-2012) and postexpansion (2015-2016). We investigated changes in cancer staging, treatment decisions, and surgical outcomes. RESULTS: In this national cohort, pancreatic cancer patients in expansion states had increased Medicaid coverage relative to those in nonexpansion states (DID = 17.49, p < 0.01). Medicaid expansion also led to an increase in early-stage diagnoses (Stage I/II, DID = 4.71, p = 0.03), higher comorbidity scores among surgical patients (Charlson/Deyo score 0: DID = -13.69, p = 0.02), a trend toward more neoadjuvant radiation (DID = 6.15, p = 0.06), and more positive margins (DID = 11.69, p = 0.02). There were no differences in rates of surgery, postoperative outcomes, or overall survival. CONCLUSION: Medicaid expansion was associated with improved insurance coverage and earlier stage diagnoses for Medicaid and uninsured pancreatic cancer patients, but similar surgical outcomes and overall survival. These findings highlight both the benefits of Medicaid expansion and the potential limitations of policy change to improve outcomes for such an aggressive malignancy.
BACKGROUND: Medicaid expansion under the Affordable Care Act has improved access to screening and treatment for certain cancers. It is unclear how this policy has affected the diagnosis and management of pancreatic cancer. METHODS: Using a quasi-experimental difference-in-differences (DID) approach, we analyzed Medicaid and uninsured patients in the National Cancer Data Base during two time periods: pre-expansion (2011-2012) and postexpansion (2015-2016). We investigated changes in cancer staging, treatment decisions, and surgical outcomes. RESULTS: In this national cohort, pancreatic cancer patients in expansion states had increased Medicaid coverage relative to those in nonexpansion states (DID = 17.49, p < 0.01). Medicaid expansion also led to an increase in early-stage diagnoses (Stage I/II, DID = 4.71, p = 0.03), higher comorbidity scores among surgical patients (Charlson/Deyo score 0: DID = -13.69, p = 0.02), a trend toward more neoadjuvant radiation (DID = 6.15, p = 0.06), and more positive margins (DID = 11.69, p = 0.02). There were no differences in rates of surgery, postoperative outcomes, or overall survival. CONCLUSION: Medicaid expansion was associated with improved insurance coverage and earlier stage diagnoses for Medicaid and uninsured pancreatic cancer patients, but similar surgical outcomes and overall survival. These findings highlight both the benefits of Medicaid expansion and the potential limitations of policy change to improve outcomes for such an aggressive malignancy.
Authors: Eva Versteijne; Mustafa Suker; Karin Groothuis; Janine M Akkermans-Vogelaar; Marc G Besselink; Bert A Bonsing; Jeroen Buijsen; Olivier R Busch; Geert-Jan M Creemers; Ronald M van Dam; Ferry A L M Eskens; Sebastiaan Festen; Jan Willem B de Groot; Bas Groot Koerkamp; Ignace H de Hingh; Marjolein Y V Homs; Jeanin E van Hooft; Emile D Kerver; Saskia A C Luelmo; Karen J Neelis; Joost Nuyttens; Gabriel M R M Paardekooper; Gijs A Patijn; Maurice J C van der Sangen; Judith de Vos-Geelen; Johanna W Wilmink; Aeilko H Zwinderman; Cornelis J Punt; Casper H van Eijck; Geertjan van Tienhoven Journal: J Clin Oncol Date: 2020-02-27 Impact factor: 44.544
Authors: Jennifer L Miller-Ocuin; Mazen S Zenati; Lee M Ocuin; Patrick R Varley; Stephanie M Novak; Sharon Winters; Amer H Zureikat; Herbert J Zeh; Melissa E Hogg Journal: Ann Surg Oncol Date: 2017-05-22 Impact factor: 5.344
Authors: Andrew P Loehrer; David C Chang; Matthew M Hutter; Zirui Song; Keith D Lillemoe; Andrew L Warshaw; Cristina R Ferrone Journal: J Am Coll Surg Date: 2015-10-09 Impact factor: 6.113
Authors: Emanuel Eguia; Adrienne N Cobb; Anai N Kothari; Ayrin Molefe; Majid Afshar; Gerard V Aranha; Paul C Kuo Journal: Ann Surg Date: 2018-10 Impact factor: 12.969
Authors: Samer Tohme; Christof Kaltenmeier; Patrick Bou-Samra; Patrick R Varley; Allan Tsung Journal: Ann Surg Oncol Date: 2018-07-24 Impact factor: 5.344
Authors: Atsushi Oba; Felix Ho; Quoc Riccardo Bao; Mohammed H Al-Musawi; Richard D Schulick; Marco Del Chiaro Journal: Front Oncol Date: 2020-02-28 Impact factor: 6.244
Authors: Erin M Mobley; Ian Tfirn; Christina Guerrier; Michael S Gutter; Kim Vigal; Keouna Pather; Brett Baskovich; Ziad T Awad; Alexander S Parker Journal: J Am Coll Surg Date: 2022-01-01 Impact factor: 6.532