In a study reported in the Journal of Clinical Oncology, Zhao et al found that patients with non–small cell lung cancer (NSCLC) in Medicaid expansion states have had improvements in earlier diagnosis, early initiation of treatment, and survival.
Study Details
In the study, patients newly diagnosed with stage I to IV NSCLC at age 18 to 64 years between January 2004 and December 2023 in 50 states and Washington, DC, were identified from the National Cancer Database. The study examined the association of Medicaid expansion with: early-stage diagnosis (stage I and II); timely initiation of guideline-concordant treatment within 30 days after diagnosis; receipt of all first-course guideline-concordant treatment; and 5-year overall survival.
Key Findings
Compared with patients in nonexpansion states (n = 164,228), those in expansion states (n = 350,290) were more likely to be female, White, or living in areas with higher family income or in nonmetropolitan areas.
Medicaid expansion vs nonexpansion was associated with increased early-stage diagnosis (difference-in-differences [DID] = 1.02 percentage points, 95% confidence interval [CI] = 0.52–1.52 percentage points), increased timely treatment initiation with guideline-concordant treatment (DID = 2.10 percentage points, 95% CI = 0.05–4.15 percentage points), and higher 5-year overall survival (DID = 1.79 percentage points, 95% CI = 1.32–2.26 percentage points). No difference in receipt of all first-course treatment was observed.
In analysis stratifying for key factors, the increase in survival associated with Medicaid expansion was greater for patients aged 60 to 64 years, Black patients, and patients living in low-income areas.
The investigators estimated that “2,086 people with NSCLC per year could benefit if the 10 remaining states expanded Medicaid, and that an average of 5,329 people with NSCLC per year could be adversely affected if expansion were reversed in the 40 states and Washington, DC.”
They concluded: “Medicaid expansion was associated with improvements in early detection, timeliness of guideline-concordant treatment, and survival for people with NSCLC. Anticipated Medicaid coverage losses may jeopardize these gains.”
Jingxuan Zhao, PhD, MPH, of Surveillance, Prevention & Health Services Research, American Cancer Society, Atlanta, Georgia, is the corresponding author for the Journal of Clinical Oncology article.
DISCLOSURE: The study was supported by the American Cancer Society. For full disclosures of the study authors, visit ascopubs.com.
