“A paucity of studies looks at how Medicaid expansion affects cancer treatment and outcomes, as our study did,” said lead author Richard S. Hoehn, MD, surgical oncology fellow with the University of Pittsburgh Medical Center (UPMC) department of surgery at UPMC Hillman Cancer Center, Pittsburgh, Pa., in a press release. “Our study also differed from others in that we analyzed data only from people who were most likely affected by Medicaid expansion: those aged 40 to 64 who had Medicaid or no health insurance.”
The researchers implemented a difference-in-differences (DID) strategy to assess Medicaid and uninsured patients using the National Cancer Data Base. Patients were stratified by pre (2011-12) and post-Medicaid expansion (2015-16). For patients in non-expansion states, comparisons were made to patients in January 2014 expansion states in terms of changes in patient/facility characteristics, cancer stage, treatment choices, and operative outcomes.
Among patients in expansion states, increases were observe in stage I diagnoses (DID=2.97, P=0.035), distance traveled in miles (DID=6.67, P=0.005), and treatment at integrated network programs (DID=2.67, P=0.005). Early stage patients were more likely to receive treatment within 30 days (DID=7.24, P=0.035), and patients with stage IV disease were more likely to receive palliative care (DID=5.01, P=0.048). Expansion reduced urgent cases (<7 days, DID=–5.88, P=0.008) and increased minimally invasive surgery (DID=5.00, P=0.022) in operative patients. Postoperative outcomes and adjuvant chemotherapy did not largely differ between the groups.
“Studies show that patients who are diagnosed with cancer at an earlier stage are more likely to have better treatment options, improved quality of care, and longer survival,” said senior investigator Samer T. Tohme, MD, surgical oncologist at UPMC Hillman Cancer Center and assistant professor of surgery at the University of Pittsburgh School of Medicine.
The study was published in the Journal of the American College of Surgeons.
“Studies like ours are building an increasing body of work that suggests the Affordable Care Act and Medicaid expansion are improving health care access and treatment for cancer patients,” said Dr. Hoehn.