The expansion of Medicaid coverage under the Affordable Care Act may be associated with the largest increases in critical palliative care services for patients with advanced cancers in the United States, according to a new study published by Han et al in Health Affairs. The findings uncovered how patients' area of residence may determine their use of palliative care.
“Our findings are encouraging, especially with growing evidence of the important benefits of palliative care for patients with cancer,” highlighted lead study author Xuesong Han, PhD, Scientific Director of Health Services Research in the Department of Surveillance & Health Equity Science at the American Cancer Society. “It’s imperative to know how to target ways to increase access to these services, as use, overall, still remains low in the United States,” she added.
Study Methods and Results
In the new study, investigators used the National Cancer Database to examine the data of patients aged 18 to 64 years with newly diagnosed stage IV cancers from 2010 to 2019. The investigators discovered that the number of eligible patients who received palliative care increased from 17.0% prior to Medicaid expansion to 18.9% postexpansion in Medicaid expansion states and from 15.7% to 16.7% in nonexpansion states. The investigators also determined that palliative care associated with Medicaid expansion was largest for patients with advanced pancreatic cancer, colorectal cancer, lung cancer, oral cavity and pharynx cancers, and non-Hodgkin lymphoma.
Conclusions
“These study results suggest that the expansion of Medicaid coverage may increase palliative care use. They also point to a potentially widening geographic disparity in receipt of guideline-recommended palliative care between states with different health policies regarding income-based Medicaid eligibility requirements,” emphasized Dr. Han.
“Research continues to underscore the impact increasing access to comprehensive, affordable health insurance through Medicaid has on [survival for patients with] cancer and the further importance of providing greater access to palliative care services to those positive outcomes. The American Cancer Society Cancer Action Network (ACS CAN) has led legislation in states to support palliative care access and continues to advocate for legislation at the federal level to promote increased access to supportive care at any age or stage of diagnosis nationwide,” stated Lisa Lacasse, MBA, President of the ACS CAN.
“To fully improve patient quality of life, Congress should prioritize legislation that educates patients and providers about the availability and benefits of palliative care and expand federal palliative care research. It’s also crucial all remaining states expand access to Medicaid as access to comprehensive health care is key to closing the gap on the health inequities we see in these underserved areas and ensure everyone has a fighting chance against cancer,” she concluded.
Disclosure: For full disclosures of the study authors, visit healthaffairs.org.
