18 Jan Medicaid Expansion Linked to Improved Access for Head and Neck Cancer Patients
MedicalResearch.com Interview with:
Evan M. Graboyes, MD
Surveillance and Health Services Research
American Cancer Society, Atlanta, Georgia
Department of Otolaryngology–Head & Neck Surgery
Medical University of South Carolina, Charleston
MedicalResearch.com: What is the background for this study?
Response: Prior studies have shown that Medication Expansions under the Patient Protection and Affordable Care Act (ACA) are associated with a decrease in uninsured individuals and increases in the percentage of nonelderly patients diagnosed with localized (stage I-II) cancer, primarily for cancers for which effective screening tests exist.
Because no screening test exists for head and neck squamous cell carcinoma (HNSCC), access to care for physical examination and tissue-based biopsy- and thus health insurance coverage- are critical for the timely recognition of symptoms, early disease stage at diagnosis, and treatment initiation.
However, the downstream association of changes in health insurance coverage following Medicaid expansion under the ACA with stage at diagnosis and time to treatment initiation, key metrics for access to care for HNSCC, remain unknown.
MedicalResearch.com: What are the main findings?
The main study findings are that in this cohort study of 90,789 patients with newly diagnosed head and neck squamous cell carcinoma are:
(1) The percentage of patients with head and neck squamous cell carcinoma with Medicaid increased more in expansion states after the implementation of the ACA than it did in non-expansion states.
(2) The percentage of patients with localized (Stage I-II) HNSCC at diagnosis increased in expansion states compared with non-expansion states.
(3) Time-to-treatment initiation decreased for patients with non-oropharyngeal SCC in expansion states relative to non-expansion states.
MedicalResearch.com: What should readers take away from your report?
Response: Medicaid expansions under the ACA were associated with improved access to care for patients with HNSCC which resulted in more patients with localized (Stage I-II) head and neck squamous cell carcinoma at diagnosis and shorter time to starting treatment. Selective Medicaid expansion may exacerbate existing regional disparities in access to care and outcomes for patients with head and neck squamous cell carcinoma.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Due to limited duration of follow-up, the current study was unable to analyze the association of changes in health insurance coverage with oncologic outcomes (such as cancer recurrence and/or survival). Future studies should explore how improved access to care and timely treatment initiation following Medicaid expansion effects HNSCC recurrence and survival.
Although we demonstrated an association between increases in the percentage of Medicaid insured patients with head and neck squamous cell carcinoma in expansion states and an increase in the percentage of patients with localized HNSCC at diagnosis, the underlying reason for the association cannot be known from our data and should be evaluated in future studies.
No disclosures or financial conflicts of interest.
This work was supported by the American Cancer Society Intramural Research Department (Drs Sineshaw, Yabroff, Han, and Jemal), the National Cancer Institute at the National Institutes of Health (grants K12CA157688 and K08CA237858 [Dr Graboyes]), and the Doris Duke Charitable Foundation (grant DDCF2015209 [Dr Graboyes]).
Sineshaw HM, Ellis MA, Yabroff KR, et al. Association of Medicaid Expansion Under the Affordable Care Act With Stage at Diagnosis and Time to Treatment Initiation for Patients With Head and Neck Squamous Cell Carcinoma. JAMA Otolaryngol Head Neck Surg. Published online January 16, 2020. doi:10.1001/jamaoto.2019.4310
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