Medicaid expansion and the management of pancreatic cancer.
Medicaid expansion
health insurance
healthcare policy
pancreatic cancer
Journal
Journal of surgical oncology
ISSN: 1096-9098
Titre abrégé: J Surg Oncol
Pays: United States
ID NLM: 0222643
Informations de publication
Date de publication:
Sep 2021
Sep 2021
Historique:
revised:
02
04
2021
received:
06
02
2021
accepted:
16
04
2021
pubmed:
4
5
2021
medline:
24
8
2021
entrez:
3
5
2021
Statut:
ppublish
Résumé
Medicaid expansion under the Affordable Care Act has improved access to screening and treatment for certain cancers. It is unclear how this policy has affected the diagnosis and management of pancreatic cancer. Using a quasi-experimental difference-in-differences (DID) approach, we analyzed Medicaid and uninsured patients in the National Cancer Data Base during two time periods: pre-expansion (2011-2012) and postexpansion (2015-2016). We investigated changes in cancer staging, treatment decisions, and surgical outcomes. In this national cohort, pancreatic cancer patients in expansion states had increased Medicaid coverage relative to those in nonexpansion states (DID = 17.49, p < 0.01). Medicaid expansion also led to an increase in early-stage diagnoses (Stage I/II, DID = 4.71, p = 0.03), higher comorbidity scores among surgical patients (Charlson/Deyo score 0: DID = -13.69, p = 0.02), a trend toward more neoadjuvant radiation (DID = 6.15, p = 0.06), and more positive margins (DID = 11.69, p = 0.02). There were no differences in rates of surgery, postoperative outcomes, or overall survival. Medicaid expansion was associated with improved insurance coverage and earlier stage diagnoses for Medicaid and uninsured pancreatic cancer patients, but similar surgical outcomes and overall survival. These findings highlight both the benefits of Medicaid expansion and the potential limitations of policy change to improve outcomes for such an aggressive malignancy.
Sections du résumé
BACKGROUND
BACKGROUND
Medicaid expansion under the Affordable Care Act has improved access to screening and treatment for certain cancers. It is unclear how this policy has affected the diagnosis and management of pancreatic cancer.
METHODS
METHODS
Using a quasi-experimental difference-in-differences (DID) approach, we analyzed Medicaid and uninsured patients in the National Cancer Data Base during two time periods: pre-expansion (2011-2012) and postexpansion (2015-2016). We investigated changes in cancer staging, treatment decisions, and surgical outcomes.
RESULTS
RESULTS
In this national cohort, pancreatic cancer patients in expansion states had increased Medicaid coverage relative to those in nonexpansion states (DID = 17.49, p < 0.01). Medicaid expansion also led to an increase in early-stage diagnoses (Stage I/II, DID = 4.71, p = 0.03), higher comorbidity scores among surgical patients (Charlson/Deyo score 0: DID = -13.69, p = 0.02), a trend toward more neoadjuvant radiation (DID = 6.15, p = 0.06), and more positive margins (DID = 11.69, p = 0.02). There were no differences in rates of surgery, postoperative outcomes, or overall survival.
CONCLUSION
CONCLUSIONS
Medicaid expansion was associated with improved insurance coverage and earlier stage diagnoses for Medicaid and uninsured pancreatic cancer patients, but similar surgical outcomes and overall survival. These findings highlight both the benefits of Medicaid expansion and the potential limitations of policy change to improve outcomes for such an aggressive malignancy.
Identifiants
pubmed: 33939838
doi: 10.1002/jso.26515
pmc: PMC8653429
mid: NIHMS1759698
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
324-333Subventions
Organisme : NCI NIH HHS
ID : T32 CA113263
Pays : United States
Informations de copyright
© 2021 Wiley Periodicals LLC.
Références
J Am Coll Surg. 2015 Dec;221(6):1015-22
pubmed: 26611798
Ann Surg Oncol. 2018 Nov;25(12):3427-3435
pubmed: 30043318
J Clin Oncol. 2017 Dec 10;35(35):3906-3915
pubmed: 28885865
Ann Surg Oncol. 2017 Aug;24(8):2387-2396
pubmed: 28534079
Front Oncol. 2020 Feb 28;10:245
pubmed: 32185128
JAMA. 2016 Aug 2;316(5):525-32
pubmed: 27400401
Health Equity. 2019 Oct 29;3(1):532-540
pubmed: 31663065
J Clin Oncol. 2020 Jun 1;38(16):1763-1773
pubmed: 32105518
Am J Public Health. 2018 Feb;108(2):216-218
pubmed: 29267058
Ann Surg. 2018 Oct;268(4):584-590
pubmed: 30004928
Health Serv Res. 2018 Aug;53 Suppl 1:2870-2891
pubmed: 28664993
Ann Surg Oncol. 2020 Feb;27(2):333-341
pubmed: 31605347
J Surg Res. 2012 Sep;177(1):55-62
pubmed: 22482767
JAMA Oncol. 2018 Dec 1;4(12):1713-1720
pubmed: 30422152
CA Cancer J Clin. 2020 May;70(3):165-181
pubmed: 32202312
PLoS One. 2018 Jun 13;13(6):e0198771
pubmed: 29897976
J Am Coll Surg. 2021 Feb;232(2):146-156.e1
pubmed: 33242599
J Surg Oncol. 2014 Jun;109(7):629-30
pubmed: 24464362
Ann Surg Oncol. 2018 Jul;25(7):1860-1867
pubmed: 29691733
JAMA Surg. 2016 Apr;151(4):338-45
pubmed: 26581025
J Am Coll Surg. 2019 Apr;228(4):342-353.e1
pubmed: 30802505