2019 ASCO: Effect of ACA Implementation on Diagnosis and Treatment of Ovarian Cancer in Women Under 65
An analysis of data from the National Cancer Database found that after implementation of the 2010 Affordable Care Act (ACA), ovarian cancer was diagnosed and treated at an earlier stage among women younger than age 65. More women also received treatment within 30 days of diagnosis, thereby increasing chances of survival. The study was presented by Smith et al at the 2019 ASCO Annual Meeting (Abstract LBA5563).
“Detecting and treating ovarian cancer at an early stage saves lives and lowers health-care costs compared to treatment of cancer at a more advanced, incurable stage,” said lead study author Anna Jo Smith, MD, MPH, a resident in the Johns Hopkins Department of Gynecology and Obstetrics. “Having health insurance plays a major role in whether or not a woman has access to care providers who can monitor symptoms and act on those symptoms if necessary.”
Study Methods
The researchers examined ovarian cancer data from the National Cancer Database, which captures data on approximately 70% of all new ovarian cancer cases. Researchers collected data on women diagnosed and treated from 2004 to 2009 (pre-ACA; 35,842 patients) and 2011 to 2014 (post-ACA; 37,145 patients). They assessed data based on stage at ovarian cancer diagnosis and time to treatment for women aged 21 to 64 years.
The investigators compared this group with a similar-sized group of women aged 65 and older. The 65 and older group was considered the control, or comparison group, as they had access to Medicare, and hence had a much lower risk of being uninsured either pre- or post-ACA.
The investigators looked at the type of insurance women had and adjusted for race, rural demographics, neighborhood household income, education level, distance traveled for care, census region, practice setting where they received care, and Charlson comorbidity score.
Results
The researchers used a “difference in differences” approach for the analysis that compares changes over time between two groups. They calculated that, compared with women 65 and older, there was a relative gain of 1.7% in early-stage diagnosis (defined as stage I or II) of ovarian cancer. There was also a relative improvement of 1.6% in women being treated within 30 days of diagnosis for those aged 21 to 64 as compared with women 65 and older.
Researchers also found that women who received public insurance post-ACA saw the greatest benefits—relative gains of 2.5% in early-stage diagnosis and timely treatment in those aged 21 to 64 compared with women aged 65 and older. All the above improvements were seen regardless of race, income, or educational level groups.
The researchers are now looking at the years beyond 2014 to glean additional insights, as well as correlation of ACA implementation with trends in other gynecologic cancers.
Disclosure: This study was funded by a Johns Hopkins Department of Gynecology and Obstetrics Kelly Society Grant. For full disclosures of the study authors, visit coi.asco.org.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
