Medicaid expansion and the management of pancreatic cancer

Hoehn, Richard S.; Rieser, Caroline; Phelos, Heather; Sabik, Lindsay M.; Nassour, Ibrahim; Khan, Sidrah; Kaltenmeier, Christof; Paniccia, Alessandro; Zureikat, Amer H.; Tohme, Samer

doi:10.1002/jso.26515

Cited by 18 publications

(4 citation statements)

References 24 publications

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“…A key aspect of the DID approach is the assumption of parallel trends between ME and NE states in the pre‐2014 period 23 . The parallel trends assumption was first assessed with visual inspection of unadjusted trends and by conducting a falsification test by fitting a regression model for each outcome that included an interaction term between state expansion status and diagnosis year during the pre‐expansion period, as done in prior DID studies 17,19,20,24–29 . Year by expansion group interaction terms for TTI outcomes were not statistically significant for nearly all cancer types except for breast cancer.…”

Section: Methodsmentioning

confidence: 99%

Effect of Medicaid expansion on cancer treatment and survival among Medicaid beneficiaries and the uninsured

Primm,

Zhao,

Adjei

et al. 2024

Cancer Medicine

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BackgroundThe Affordable Care Act expanded Medicaid coverage for people with low income in the United States. Expanded insurance coverage could promote more timely access to cancer treatment, which could improve overall survival (OS), yet the long‐term effects of Medicaid expansion (ME) remain unknown. We evaluated whether ME was associated with improved timely treatment initiation (TTI) and 3‐year OS among patients with breast, cervical, colon, and lung cancers who were affected by the policy.MethodsMedicaid‐insured or uninsured patients aged 40–64 with stage I–III breast, cervical, colon, or non‐small cell lung cancer within the National Cancer Database (NCDB). A difference‐in‐differences (DID) approach was used to compare changes in TTI (within 60 days) and 3‐year OS between patients in ME states versus nonexpansion (NE) states before (2010–2013) and after (2015–2018) ME. Adjusted DID estimates for TTI and 3‐year OS were calculated using multivariable linear regression and Cox proportional hazards regression models, respectively.ResultsME was associated with a relative increase in TTI within 60 days for breast (DID = 4.6; p < 0.001), cervical (DID = 5.0 p = 0.013), and colon (DID = 4.0, p = 0.008), but not lung cancer (p = 0.505). In Cox regression analysis, ME was associated with improved 3‐year OS for breast (DID hazard ratio [HR] = 0.82, p = 0.009), cervical (DID‐HR = 0.81, p = 0.048), and lung (DID‐HR = 0.87, p = 0.003). Changes in 3‐year OS for colon cancer were not statistically different between ME and NE states (DID‐HR, 0.77; p = 0.075).ConclusionsFindings suggest that expanded insurance coverage can improve treatment and survival outcomes among low income and uninsured patients with cancer. As the debate surrounding ME continues nationwide, our findings serve as valuable insights to inform the development of policies aimed at fostering accessible and affordable healthcare for all.

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Section: Methodsmentioning

confidence: 99%

Effect of Medicaid expansion on cancer treatment and survival among Medicaid beneficiaries and the uninsured

Primm,

Zhao,

Adjei

et al. 2024

Cancer Medicine

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“…Medicaid expansion has been associated with earlier diagnoses, fewer treatment delays, and more treatment options being available for patients with cancer. An association between Medicaid expansion and an increase in early-stage diagnoses has been reported in patients with breast cancer [30], squamous cell carcinoma of the head and neck [31], gynecologic cancer [32], intrahepatic cholangiocarcinoma [33], hepatocellular carcinoma [34], gastric cancer [35], kidney cancer [36], pancreatic cancer [37], and melanoma [38]. Medicaid expansion has also been associated with an improved time in the initiation of treatment for Black and Hispanic patients with early-stage breast cancer who require adjuvant chemotherapy [39], and for patients with non-oropharyngeal HNSCC [40] and gynecologic cancers [32].…”

Section: Enhanced Quality Of Carementioning

confidence: 99%

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

et al. 2023

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Since 2014, American states have had the option to expand their Medicaid programs as part of the Affordable Care Act (ACA), which was signed into law by former President Barack H. Obama in 2010. Emerging research has found that Medicaid expansion has had a significant impact on patients with cancer, who often face significant financial barriers to receiving the care they need. In this review, we aim to provide a comprehensive examination of the research conducted thus far on the impact of Medicaid expansion on patients with cancer. We begin with a discussion of the history of Medicaid expansion and the key features of the ACA that facilitated it. We then review the literature, analyzing studies that have investigated the impact of Medicaid expansion on cancer patients in terms of access to care, quality of care, and health outcomes. Our findings suggest that Medicaid expansion has had a positive impact on patients with cancer in a number of ways. Patients in expansion states are more likely to receive timely cancer screening and diagnoses, and are more likely to receive appropriate cancer-directed treatment. Additionally, Medicaid expansion has been associated with improvements in cancer-related health outcomes, including improved survival rates. However, limitations and gaps in the current research on the impact of Medicaid expansion on patients with cancer exist, including a lack of long-term data on health outcomes. Additionally, further research is needed to better understand the mechanisms through which Medicaid expansion impacts cancer care.

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“…4,12,13 In contrast, other investigators have failed to confirm an association between ME and early diagnosis for pancreatic cancer. 13,14 To date, the impact of ME implementation on BTCs care has not been well defined. As such, the objective of the current study was to define the impact of ME on receipt of multimodal care, including surgical resection, for stage I-III BTC utilizing a nationwide cohort.…”

Section: Introductionmentioning

confidence: 99%

“…For instance, previous research on pancreatic adenocarcinoma (PDAC) and intrahepatic cholangiocarcinoma (ICC) demonstrated an association between ME and better access to surgical and palliative therapies, as well as increased early cancer detection and improved outcomes 4,12,13 . In contrast, other investigators have failed to confirm an association between ME and early diagnosis for pancreatic cancer 13,14 . To date, the impact of ME implementation on BTCs care has not been well defined.…”

Section: Introductionmentioning

confidence: 99%

Impact of Medicaid expansion on the multimodal treatment of biliary tract cancer

Ortiz Rueda,

Endo,

Tsilimigras

et al. 2023

Journal of Surgical Oncology

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IntroductionThe impact of Medicaid expansion (ME) on the treatment of patients with cancer remains controversial, especially individuals requiring complex multidisciplinary care. We sought to evaluate the impact of Medicaid expansion (ME) on receipt of multimodal care, including surgical resection, for Stage I–III biliary tract cancer (BTC).MethodsPatients diagnosed with BTC between 40 and 65 years of age were identified from the National Cancer Database and divided into pre‐ (2008–2012) and post‐ (2015–2018) ME cohorts. Difference‐in‐difference (DID) analysis was used to determine the impact of ME on the utilization of surgery and multimodal chemotherapy and/or radiotherapy treatment for BTC.ResultsAmong 12,415 patients with BTC (extrahepatic, n = 5622, 45.3%; intrahepatic, n = 4352, 35.1%; gallbladder, n = 1944, 15.7%; overlapping, n = 497, 4.0%), 5835 (47.0%) and 6580 (53.0%) patients were diagnosed before versus after ME, respectively. Overall utilization of surgery (OR 1.13, 95% CI 1.02–1.26) and multimodality therapy (OR 1.13, 95% CI 1.01–1.27) increased in states that adopted ME. Utilization of surgery among uninsured/Medicaid patients in ME states increased relative to patients living in non‐ME states (∆+10.1%, p = 0.01). Similarly, the use of multimodal treatment increased among uninsured/Medicaid patients living in ME versus non‐ME states (∆+6.4%, p = 0.04); in contrast, there were no difference among patients with other insurance statuses (overall: ∆+1.5%, private: ∆−2.0%, other: ∆+3.9%, all p > 0.5). Uninsured/Medicaid patients with BTC who lived in a ME state had a lower risk of long‐term death in the post‐ME era (HR 0.81, 95% CI 0.67–0.98; p = 0.03).ConclusionsImplementation of ME positively impacted survival among patients who underwent surgical and multimodal treatment for Stage I–III BTC.

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Medicaid expansion and the management of pancreatic cancer

Cited by 18 publications

References 24 publications

Effect of Medicaid expansion on cancer treatment and survival among Medicaid beneficiaries and the uninsured

Effect of Medicaid expansion on cancer treatment and survival among Medicaid beneficiaries and the uninsured

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

Impact of Medicaid expansion on the multimodal treatment of biliary tract cancer

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