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Medicaid expansion and the management of pancreatic cancer
Author(s) -
Hoehn Richard S.,
Rieser Caroline J.,
Phelos Heather,
Sabik Lindsay M.,
Nassour Ibrahim,
Khan Sidrah,
Kaltenmeier Christof,
Paniccia Alessandro,
Zureikat Amer H.,
Tohme Samer T.
Publication year - 2021
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.26515
Subject(s) - medicaid , medicine , pancreatic cancer , cancer , cohort , malignancy , comorbidity , stage (stratigraphy) , emergency medicine , health care , family medicine , paleontology , economics , biology , economic growth
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 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 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 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.