Where You Live Matters: A National Cancer Database Study of Medicaid Expansion and Endometrial Cancer Outcomes

Abstract

(Abstracted from Gynecol Oncol 2020;158(2):407–414) Individuals diagnosed with endometrial cancer (EC) and presenting with early-stage disease have favorable outcomes and a high probability of cure compared with those presenting with advanced disease. Aggressive early interventions including surgery that contribute to good outcomes may be less available for those with various barriers to screening and health care access, including lacking insurance coverage.

Disparities in Timeliness of Endometrial Cancer Care

“…Black, Asian, and other or unknown race; less insurance coverage; and lower socioeconomic status were associated with longer time from diagnosis until treatment 13,34,35,45,46 and more advanced stage at diagnosis. [10][11][12][13][14][15][16][17][18] However, we identified no studies that address how these factors create community-level barriers to accessing timely treatment. Studies are needed to guide intervention design.…”

“…The scope of literature on the appraisal and helpseeking intervals disproportionately investigates patient-driven delays, outlining the neoliberal perspective that individuals are ultimately responsible for their health outcomes. 52 Stage of endometrial cancer is associated with access to primary care 53 and insurance, 12,14,15 pointing toward expanded health care access as a means to shorten, or even bypass, the appraisal and help-seeking intervals. The role of infrastructure, politics, racism, and other "isms" in creating conditions for poor endometrial cancer outcomes warrants further study.…”

“…1 Advanced endometrial cancer stage is associated with lower median family income, 10 lower neighborhood socioeconomics, 11 and less insurance coverage. [12][13][14][15] Disparities in endometrial cancer stage attributable to racism are particularly egregious and well demonstrated 10,[16][17][18] and, if resolved, could reduce the 5-year mortality for Black people by 33%. 8 Aside from Medicaid expansion, reducing endometrial cancer stage in the United States has seen little progress.…”

“…8 Aside from Medicaid expansion, reducing endometrial cancer stage in the United States has seen little progress. [13][14][15] When an issue requires swift action, literature reviews serve crucial roles. They aim to assist researchers in building on (rather than recapitulating) existent evidence, to reduce time to translation and implementation of evidence-based practices, and to reveal the paradigm of a scientific community such that it can be checked against lived experiences.…”