Colorectal Cancer Care Among Young Adult Patients After the Dependent Coverage Expansion Under the Affordable Care Act.
Adult
Chemotherapy, Adjuvant
/ economics
Colorectal Neoplasms
/ diagnosis
Cytoreduction Surgical Procedures
/ economics
Early Detection of Cancer
/ economics
Female
Humans
Male
Patient Protection and Affordable Care Act
/ statistics & numerical data
Proportional Hazards Models
United States
/ epidemiology
Young Adult
Journal
Journal of the National Cancer Institute
ISSN: 1460-2105
Titre abrégé: J Natl Cancer Inst
Pays: United States
ID NLM: 7503089
Informations de publication
Date de publication:
01 10 2020
01 10 2020
Historique:
received:
16
10
2019
revised:
02
12
2019
accepted:
11
12
2019
pubmed:
20
12
2019
medline:
20
4
2021
entrez:
20
12
2019
Statut:
ppublish
Résumé
The effect of the Dependent Coverage Expansion (DCE) under the Affordable Care Act (ACA) on receipt of colorectal cancer treatment has yet to be determined. We identified newly diagnosed DCE-eligible (aged 19-25 years, n = 1924) and DCE-ineligible (aged 27-34 years, n = 8313) colorectal cancer patients from the National Cancer Database from 2007 to 2013. All statistical tests were two-sided. Post-ACA, there was a statistically significant increase in early-stage diagnosis among DCE-eligible (15 percentage point increase, confidence interval = 9.8, 20.2; P < .001), but not DCE-ineligible (P = .09), patients. DCE-eligible patients resected for IIB-IIIC colorectal cancer were more likely to receive timely adjuvant chemotherapy (hazard ratio = 1.34, 95% confidence interval = 1.05 to 1.71; 7.0 days' decrease in restricted mean time from surgery to chemotherapy, P = .01), with no differences in DCE-ineligible patients (hazard ratio = 1.10, 95% confidence interval = 0.98 to 1.24; 2.1 days' decrease, P = .41) post-ACA. Our findings highlight the role of the ACA in improving access to potentially lifesaving cancer care, including a shift to early-stage diagnosis and more timely receipt of adjuvant chemotherapy.
Identifiants
pubmed: 31854444
pii: 5679791
doi: 10.1093/jnci/djz235
pmc: PMC7566337
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1063-1066Informations de copyright
© The Author(s) 2019. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.
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