Impact of Medicaid Expansion on the Diagnosis, Treatment, and Outcomes of Stage II and III Rectal Cancer Patients

Abstract

BACKGROUND: Insurance status has been associated with disparities in stage at cancer diagnosis. We examined how Medicaid expansion (ME) impacted diagnoses, surgical treatment, use of neoadjuvant therapies (NCRT), and outcomes for Stage II and III rectal cancer. STUDY DESIGN: We used 2010-2017 American College of Surgeons National Cancer Database (NCDB) to identify patients ages 18-65, with Medicaid as primary form of payment, and were diagnosed with Stage II or III rectal cancer. Patients were stratified based on Census bureau division’s ME adoption rates of High, Medium, Low. Overall trends were examined, and patient characteristics and outcomes were compared before and after ME date of 1/1/2014. RESULTS: Over 8 years of NCDB data examined, there was an increasing trend of Stage II and III rectal cancer diagnoses, surgical resection, and use of NCRT for Medicaid patients. We observed an increase in age, proportion of White Medicaid patients in Low ME divisions, and proportion of fourth income quartile patients in High ME divisions. Univariate analysis showed decreased use of open surgery for all 3 categories after ME, but adjusted odds ratios (aOR) were not significant based on multivariate analysis. NCRT utilization increased after ME for all 3 ME adoption categories and aOR significantly increased for Low and High ME divisions. ME significantly decreased 90-day mortality. CONCLUSIONS: Medicaid expansion had important impacts on increasing Stage II and III rectal cancer diagnoses, use of NCRT, and decreased 90-day mortality for patients with Medicaid. Our study supports increasing health insurance coverage to improve Medicaid patient outcomes in rectal cancer care.

The Impact of Medicaid Expansion on Patients with Cancer in the United States: A Review

“…Medicaid expansion was also associated with improvements in 1-year survival among patients with ovarian cancer, and this was felt to be mediated by more timely and earlier diagnoses [51]. Similarly, Medicaid expansion was shown to significantly decrease the 90-day mortality rate in patients with stage II and III rectal cancer [52]. Medicaid expansion has additionally been associated with a survival benefit in patients with hepatocellular carcinoma [34], gastric cancer [35], pancreatic adenocarcinoma [53,54], and intrahepatic cholangiocarcinoma [33].…”

Influence of Health Insurance Types on Clinical Cancer Care Accessibility and Quality Using All of Us Database

“…Specifically, MES resulted in statistically significant decreases in chemotherapy delays for African American and Hispanic breast cancer patients and decreased advanced stages of disease at diagnosis for rural breast cancer patients [7,8]. Increased screening and cancer detection, and decreased mortality were also observed for Stage II and III rectal cancer patients covered by Medicaid [9].…”