Medicaid expansion and trends in cancer stage at diagnosis.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14129-e14129
Author(s):  
John Withington ◽  
Angela Tramontano ◽  
Deborah Schrag
Keyword(s):  
Early Stage ◽  
Cancer Stage ◽  
Medicaid Expansion ◽  
Tumor Site ◽  
Difference In Difference ◽  
Poverty Level ◽  
Stage Distribution ◽  
Ajcc Stage ◽  
Significant Difference ◽  
Race Ethnicity

e14129 Background: Cancer stage distribution offers an early window into the effect of the ACA’s 2014 Medicaid expansion. If Medicaid expansion enabled uninsured adults to access preventive care, then the proportion of cancers diagnosed at early stage should be higher in states that adopted it. Methods: Patient level data were retrieved from SEER-18, New York and Texas cancer registries from January 2010 to December 2015, for eight common tumor types; including N = 2,493,589 (breast, cervical, colorectal, prostate, lung) screen detectable and N = 369,203 (testis, kidney and uterine corpus) not detected by routine screening. Patients were categorized by residence in states that were: 1) Non-expanders; 2) Expanders - income eligibility thresholds increased from 0% to 138% of the federal poverty level (FPL) in 2014; and 3) Pre-Expanders, with pre-2014 eligibility thresholds > 70% of FPL. Stage distributions were compared before and after January 2014, categorized by AJCC stage and using ordinal stage equivalent (OSE) which assigns a numeric score based on AJCC stage. Difference in difference in difference (D3) methods compared patients ≥65 versus < 65, and screen-detectable versus not. Multivariable logistic regression was used to adjust for variation in age, sex, race, ethnicity and tumor site across states. Results: No differences in stage distribution were observed across the three categories of state. (Table). D3 analysis revealed no difference between trends in the over 65s, or for screen-detectable cancers. Adjustment for age, sex, race, ethnicity and tumor site made no significant difference to these results. Conclusions: States’ Medicaid expansion status in 2014 was not associated with a significant difference in early stage diagnoses for adults with cancer diagnosed before age 65. Obstacles to early cancer detection other than financial access must be addressed to improve population-level outcomes. [Table: see text]

Association of state Medicaid expansion with timeliness of cancer care delivery.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18126-e18126
Author(s):  
Samuel U Takvorian ◽  
Justin E. Bekelman ◽  
Ronac Mamtani ◽  
Lawrence N. Shulman ◽  
Rachel M. Werner
Keyword(s):  
Cancer Therapy ◽  
Early Stage ◽  
Care Delivery ◽  
Medicaid Expansion ◽  
Advanced Stage ◽  
Stage At Diagnosis ◽  
Poverty Level ◽  
Patients Âgés ◽  
Definitive Therapy ◽  
Significant Difference

e18126 Background: The Affordable Care Act (ACA) expanded Medicaid eligibility to nonelderly adults with incomes at or below 138% of the federal poverty level in participating states. Medicaid expansion has been associated with earlier cancer stage at diagnosis; however, its impact on cancer treatment is unknown. Methods: We assembled retrospective cohorts of adult nonelderly patients (ages 40-64) with newly diagnosed breast, colon and lung cancer from January 2011 to December 2015, using data from the National Cancer Database (NCDB). We conducted a quasi-experimental, difference-in-differences analysis to compare Medicaid expansion and non-expansion states on timeliness of cancer therapy, stage at diagnosis, and insurance status for the years before (2011-2013) and after ACA Medicaid expansion (2014-2015). Results: There were 466,314 patients in expansion states (mean age, 54.7 years; 81.5% women) and 487,958 patients in non-expansion states (mean age, 54.9 years; 78.5% women). In expansion states relative to non-expansion states, there was no significant difference in the proportion of patients initiating cancer therapy within 30 days (adjusted difference-in-difference (DID) estimate -0.1%; 95% CI -0.8 to +0.7%, p = 0.868) or within 90 days of diagnosis (adjusted DID estimate -0.1%; 95% CI -0.3 to +0.1%, p = 0.501), before and after expansion. Among those with early-stage cancers undergoing definitive therapy, there was similarly no significant difference in time to treatment. Relative to non-expansion states, the proportion of early stage cancer diagnoses increased more (adjusted DID estimate +0.7%; 95% CI +0.3 to +1.2%, p = 0.002), and the proportion of advanced stage cancers decreased more (adjusted DID estimate -0.4%; 95% CI -0.7 to -0.1%, p = 0.008) in expansion states. The proportion uninsured at diagnosis decreased more in expansion states (adjusted DID estimate -0.8%; 95% CI -1.2 to -0.4%, p < 0.001). Conclusions: Among nonelderly patients with common cancers, ACA Medicaid expansion was associated with an increase in the proportion of cancers diagnosed at early stage, a decrease in the proportion of cancers diagnosed at advanced stage, and a decrease in the proportion of uninsured. There was no significant effect on the timeliness of treatment.

Impact of Medicaid expansion on pancreatic cancer care: A difference-in-difference analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18567-e18567
Author(s):  
Ahmad Hamad ◽  
Mariam Eskander ◽  
Yaming Li ◽  
Oindrila Bhattacharyya ◽  
James L Fisher ◽  
...  
Keyword(s):  
Low Income ◽  
Early Stage ◽  
Ductal Adenocarcinoma ◽  
Control Group ◽  
Medicaid Expansion ◽  
Difference In Difference ◽  
Post Surgery ◽  
Number Of Patients ◽  
The Impact ◽  
Expansion Period

e18567 Background: The Affordable Care Act (ACA) increased insurance coverage for low-income individuals, which should potentially lead to better access to care and improved oncological outcomes. This study seeks to evaluate the impact of Medicaid expansion (ME) on care for pancreatic ductal adenocarcinoma (PDAC). Methods: Patients who were uninsured or on Medicaid and diagnosed with PDAC between 2004 and 2017 were queried from the National Cancer Database (NCDB). Two different expansion cohorts were included: early expansion states and 2014 expansion states. For early expansion states, the time period of pre-expansion was 2004-2009 and post-expansion was 2010-2017. As for the 2014 expansion states, the pre-expansion period was from 2004-2013 and post-expansion period was from 2014-2017. Patients in non-expansion states formed the control group. A difference-in-difference (DID) analysis was used to assess the association of ME with stage of diagnosis, treatment and survival for each expansion cohort. Results: In both early and January 2014 expansion states, there was an increase in overall Medicaid coverage (Early: DID = 0.29, 2014: DID = 0.37; P < 0.001), in particular for non-Hispanic Black and Hispanic Black patients (Non-Hispanic Black: Early: DID = 0.11, 2014: DID = 0.11; P < 0.001, Hispanic-Black: 2014: DID = 0.20; P = 0.003). There were no differences in early stage diagnosis (Early: DID = 0.02, 2014: DID = -0.02; P > 0.05). There was an increase in the number of patients receiving surgery (Early: DID = 0.05; P = 0.001, 2014: DID = 0.03; P = 0.029) but no difference in time to surgery among patients receiving surgery upfront (Early: DID = 1.75, 2014: DID = 0.38; P > 0.05). There was no difference in 30-day readmission post-surgery (Early: DID = 0.003; 2014: DID = -0.00007; P > 0.05) or 90-day mortality (Early: DID = -0.007, 2014: DID = -0.035; P > 0.05). Moreover, there was no difference in receipt of chemotherapy (Early: DID = 0.01, 2014: DID = 0.005; P > 0.05) or time to chemotherapy for patients receiving neoadjuvant chemotherapy (Early: Early: DID = 9.62, 2014: DID = 0.01; P > 0.05). Finally, there was no difference in receipt of palliative care among stage IV patients in both cohorts (Early: DID = -0.004, 2014: DID = 0.004; P > 0.05). Conclusions: This study suggests that after ME, PDAC patients were more likely to be insured and had increased access to surgical care. Future, studies should evaluate the implications of improved surgical access on clinical outcomes such as mortality.

scholarly journals Caspase-3 can not be Used to Predict the Response to Neoadjuvant Chemotherapy Regiment PVB in Cervical Cancer Stage IB-IIA

2016 ◽  
pp. 156-160
Author(s):  
Ediwibowo Ambari ◽  
Hariyono Winarto ◽  
Bambang Sutrisna ◽  
Budiningsih Siregar
Keyword(s):  
Cervical Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Caspase 3 ◽  
Early Stage ◽  
Response To Therapy ◽  
Bivariate Analysis ◽  
Chemotherapy Response ◽  
Cancer Stage ◽  
Significant Difference ◽  
Early Stage Cervical Cancer

Objectives: To determine the factors that may be used as the prognostic parameter for the therapeutic efficacy of neoadjuvant chemotherapy, which can be used to revising the management of early stage cervical cancer patients with large lesions. Methods: This was a retrospective cohort study. The study was conducted in the Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, University of Indonesia. The subjects were 15 cervical cancer stage IB2 and IIA patients with lesions’ size of > 4 cm, who would be treated with neoadjuvant chemotherapy, consisted of cisplatin 50 mg/m2, vincristine 2 mg/m2 and bleomycin 15 mg regiment. The patients’ response would be evaluated after completing 3 series of chemotherapy. Data was retrieved from medical records and cervical biopsy paraffin blocks and examined histopathologically using IHC staining to see expression of caspase-3 with histoscore assessment score. Data was analyzed by univariate, bivariate analysis. Results: Response to PVB neoadjuvant chemotherapy was found in 5 out of 15 patients. None of the clinicopathology variables can be used to predict response to therapy. Expression of caspase-3 as a marker of apoptosis, can not predict the response of the therapy before administrating neoadjuvant chemotherapy either. There is a significant difference between the levels of caspase-3 in epidermoid carcinoma with adenocarcinoma, with p value of 0.02 (RR 6;95% CI 1.69-21.26). Conclusion: Clinicopathologic factors and the expression of caspase-3 before getting chemotherapy neoadjuvant can not predict the succeed of the therapy. [Indones J Obstet Gynecol 2013; 1-3: 156-60] Keywords: caspase -3, clinicopathologic, early-stage cervical cancer lession in large, neoadjuvant chemotherapy response to therapy

Adverse consequences of the COVID-19 pandemic on breast cancer stage distribution and breast cancer disparities.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 10555-10555
Author(s):  
Genevieve A. Fasano ◽  
Yalei Chen ◽  
Solange Bayard ◽  
Melissa Davis ◽  
Vivian Bea ◽  
...  
Keyword(s):  
Breast Cancer ◽  
New York ◽  
New York City ◽  
Cancer Patients ◽  
York City ◽  
Cancer Stage ◽  
Breast Cancer Patients ◽  
Stage Distribution ◽  
Race Ethnicity ◽  
Racial Ethnic

10555 Background: The COVID-19 surge in March 2020 resulted in a hiatus placed on screening mammography programs in support of shelter-in-place mandates and diversion of medical resources to pandemic management. The COVID-related economic recession and ongoing social distancing policies continued to influence screening practices after the hiatus was lifted. We evaluated the effect of the hiatus on breast cancer stage distribution on the diverse patient population of a health care system in New York City, the first pandemic epicenter in the United States. Methods: Breast cancer patients diagnosed January 1, 2019 to December 31, 2020 were analyzed, with comparisons of stage distribution and mammography screen-detection for three intervals: Pre-Hiatus, During Hiatus (March 15, 2020 to June 15, 2020), and Post-Hiatus. Results were stratified by African American (AA), White American (WA), Asian (As) and Hispanic/Latina (Hisp) self-reported racial/ethnic identity. Results: A total of 894 patients were identified; of these, 549 WA, 100 AA, 104 As, and 93 Hisp comprised the final race/ethnicity-stratified study population. Overall, 588 patients were diagnosed Pre-Hiatus, 61 During-Hiatus, and 245 Post-Hiatus. Nearly two-thirds (65.5%) of the Pre-Hiatus cases were screen-detected versus 49.2% During-Hiatus and 54.7% Post-Hiatus (p = 0.002). Frequency of tumors diagnosed < 1 cm declined from 41.9% Pre-Hiatus to 31.7% Post-Hiatus (p = 0.035). WA patients were more likely to have screen-detected disease compared to AA in the Pre-Hiatus period (69.1% vs. 56.1%; p = 0.05) but non-significantly more likely to have screen-detected disease compared to As and Hisp patients (66.2% vs. 56.9%; p = 0.08). In the Post-Hiatus period, the frequency of screen-detected disease was highest among WA patients (63.0%) compared to all other racial/ethnic groups (AA; 48.1%, As-33.3%, and Hisp-40%; p = 0.007). Similar patterns were observed for frequency of tumors diagnosed ≤1cm Pre-Hiatus (WA-44.3% vs AA-26%, p = 0.02; and vs. As-41.3%, Hisp-48%; p = 0.09), and Post-Hiatus (WA-37.7% vs. AA-18.2%, As-30.8%, Hisp-23.5%; p = 0.25). Conclusions: The 3-month pandemic-related mammography screening hiatus resulted in a more advanced stage distribution for New York City breast cancer patients, and worsened pre-existing race/ethnicity-associated disparities, especially for AA pts.

Disentangling the effects of race/ethnicity and socioeconomic status of neighborhood in cancer stage distribution in New York City

2013 ◽  
Vol 24 (6) ◽  
pp. 1069-1078 ◽  
Author(s):  
Farhad Islami ◽  
Amy R. Kahn ◽  
Nina A. Bickell ◽  
Maria J. Schymura ◽  
Paolo Boffetta
Keyword(s):  
New York ◽  
Socioeconomic Status ◽  
New York City ◽  
York City ◽  
Cancer Stage ◽  
Stage Distribution ◽  
Race Ethnicity

Impact of late Medicaid expansion on prostate cancer screening.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 141-141 ◽  
Author(s):  
Daniel Pucheril ◽  
Dimitar V. Zlatev ◽  
Matthew Mossanen ◽  
Alexander P Cole ◽  
Matthew D. Ingham ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Health Insurance ◽  
Cancer Screening ◽  
Prostate Cancer Screening ◽  
Behavioral Risk ◽  
Medicaid Expansion ◽  
Poverty Level ◽  
Multivariable Logistic Regression Model ◽  
Significant Difference ◽  
Personal Physician

141 Background: A key provision of the Affordable Care Act (ACA) was the expansion of Medicaid to childless adults living < 138% of the federal poverty level (FPL). Aside from a few early expansion states, the majority of states adopting the provision expanded coverage in January 2014, and are categorized as late expansion states (LES). Non-expansion states (NES) opposed expansion and did not adopt these broader provisions. Our objective was to determine the effects of this policy change on prostate cancer screening (PSAS) trends in LES and NES. Methods: The 2014 and 2016 Behavioral Risk Factor Surveillance System surveys reflect 2013 and 2015 health behaviors, and were queried for men 40-64, without history of prostate cancer, with a household income < 138% FPL, and residing in NES or LES. Descriptive statistics, stratified by expansion status and year, were generated for covariates. The Chi-Square test was used to compare proportions between years within state categories. Difference-in-differences (DID) analyses were employed to compare trends in men with health insurance, a personal physician, and undergoing PSAS. Within a multivariable logistic regression model, the interaction term year*state expansion status was used to determine the significance of DID estimates. Results: A weighted 8.8 million (n = 14,979) men met inclusion criteria. PSAS significantly declined from 2014 to 2016 in both NES (22.6% to 16.4%, p = 0.0006) and LES (20.5% to 15.8%, p = 0.003). In LES, the proportion of men with health insurance significantly increased from 2014 to 2016 (75.5% to 82.7%, p = 0.0002), however the proportion of insured men in NES was constant. Additionally, the proportion of respondents with a personal physician was unchanged from 2014 to 2016 in both NES and LES. DID analysis determined a significant difference in health insurance trends between 2014 and 2016 for LES compared to NES (+6.9%, p = 0.008). DID estimates were not significant for comparisons of trends for PSAS or access to a personal physician. Conclusions: The ACA’s Medicaid expansion provision has led to significant gains in insurance coverage for eligible persons in LES compared to NES, however, these gains have not translated into significantly different rates of access to a personal physician or PSAS.

scholarly journals Long-term analysis of bilateral versus unilateral neck dissection in the treatment of early-stage supraglottic laryngeal cancer

2021 ◽  
Vol 9 (3) ◽  
pp. 81-86
Author(s):  
Selin Ünsaler
Keyword(s):  
Overall Survival ◽  
Neck Dissection ◽  
Cancer Patients ◽  
Early Stage ◽  
Survival Rates ◽  
Survival Outcomes ◽  
Tumor Site ◽  
Significant Difference ◽  
Overall Survival Rates

OBJECTIVE: This study aimed to investigate the effect of routine bilateral neck dissection on the survival outcomes of supraglottic laryngeal cancer patients with lateralized tumors and clinically negative necks. METHODS: The data of 234 patients surgically treated for supraglottic squamous cell carcinoma between January 2000 and September 2014 were retrospectively collected. Patients treated previously for head and neck cancer, patients who could not be contacted, and those with missing data were excluded. Of the remaining 187 patients, 124 patients with early-stage primaries (T1-T2) (116 males, 8 females; mean age: 55.5±9.5 years; range, 33 to 82 years) were included. Age and sex of the patients, site of the primary tumor, TNM stage, type of the neck dissection, length of follow-up, and survival rates were evaluated. The tumors were classified into three groups according to their relationship with the median line of the larynx, and the neck dissections were recorded as unilateral or bilateral. Recurrences and survival outcomes were evaluated. RESULTS: There was no statistically significant difference in the recurrences according to tumor site groups (p=0.39). Similarly, there was no statistically significant difference in 10-year overall survival rates in patient groups according to the tumor site (p=0.072). We found no statistically significant difference in 10-year overall survival rates between the patients who underwent unilateral and bilateral neck dissection (p=0.580). CONCLUSION: Long-term survival analysis of 124 patients with supraglottic carcinoma did not show a survival benefit of elective contralateral neck dissection in lateralized supraglottic cancer with contralateral clinically negative neck.

Survival in the real world: A national analysis of patients treated for early-stage breast cancer.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 75-75
Author(s):  
Jeffrey Franks ◽  
Risha Gidwani ◽  
Ene Mercy Enogela ◽  
Nicole E. Caston ◽  
Courtney Williams ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Trials ◽  
Real World ◽  
Early Stage ◽  
Individual Treatment ◽  
Cancer Stage ◽  
The Real ◽  
Race Ethnicity ◽  
National Analysis ◽  
Concurrent Cancer

75 Background: Many patient population groups are not proportionally represented in clinical trials, including patients of color, at age extremes, or with comorbidities. It is unclear how treatment outcomes may differ for these patients compared to those well represented in trials. Methods: This retrospective cohort study included women diagnosed with early-stage (I-III) breast cancer (EBC) between 2005-2015 in the CancerLinQ Discovery electronic medical record-based dataset. Patients with comorbidities or concurrent cancer were considered unrepresented in clinical trials. Non-White patients and/or those aged <45 or ≥70 years were considered underrepresented. Patients who were White and aged 45-69 were considered well represented. Overall and EBC subtype-stratified Cox proportional hazards models estimated hazard ratios (HR) and 95% confidence intervals (CI) for five-year mortality by representation group. The overall model was adjusted for cancer stage, subtype, chemotherapy intensity, and year of EBC diagnosis. Stratified models were adjusted for cancer stage, individual treatment regimen (due to lack of chemotherapy intensity variation within subtype), and year of EBC diagnosis. Results: Of 11,770 patients, most were aged 45-69 (71%), White (72%), diagnosed with stage II (51%), or HR+HER2- EBC (56%). Unrepresented patients (7%) were categorized due to comorbidities (76%), concurrent cancer (22%), or both (2%). Underrepresented patients (45%) were categorized based on age (44%), race/ethnicity (39%), or both (17%). The remaining patients were well represented in trials (48%). In adjusted models, unrepresented patients had almost three times the hazard of death than well-represented patients (HR 2.71, 95% CI 2.08-3.52; Table). The hazard of death for underrepresented versus well-represented patients was similar (HR 1.19, 95% CI 0.98-1.45). Comparable results were seen in EBC subtype-specific models. Conclusions: Over half of patients in this study would be considered underrepresented or unrepresented in clinical trials due to age, comorbidity, or race/ethnicity. Patients considered unrepresented in trials experienced poorer survival compared to those well-represented. Trialists should ensure study participants reflect the real-world disease population to support evidence-based decision making for all individuals with cancer.[Table: see text]

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