Recent data showed that Medicaid expansion may be associated with increased use of palliative care among newly diagnosed individuals with stage IV cancer, although overall usage of palliative care was low. In addition, the increase after Medicaid expansion varied by cancer type, according to a study published by Xuesong Han, PhD, and colleagues in the Journal of Clinical Oncology. The findings were also presented at the 2022 ASCO Quality Care Symposium (Abstract 73).
Xuesong Han, PhD
In the study, Dr. Han, an epidemiologist and senior principal scientist in the Surveillance & Health Equity Science Department at the American Cancer Society, and colleagues identified individuals from the National Cancer Database (aged 18 to 64) with newly diagnosed stage IV solid tumors before and after Affordable Care Act Medicaid expansion. They used difference-in-differences analyses to estimate the association between Medicaid expansion and changes in receipt of palliative care as part of first-line therapy, adjusting for age group, sex, race and ethnicity, area-level poverty, metropolitan status, comorbidity, facility type, palliative care specialist availability, diagnosis year, and state of residence. Stratified analyses were conducted by cancer type.
A total of 685,781 individuals diagnosed with stage IV cancers from Medicaid expansion and nonexpansion states were included in the study. The percentage of eligible patients who received palliative care as part of their first-line therapy increased from 17% before the Affordable Care Act to 18.9% after the Affordable Care Act in Medicaid expansion states, and from 15.7% to 16.7% in nonexpansion states, resulting in a net increase of 1.4% in expansion states after adjusting for sociodemographic and clinical factors. The increase in receipt of palliative care in expansion states compared with nonexpansion states was greater for patients with advanced pancreatic, colorectal, breast, lung, and oropharyngeal cancers, as well as those with non-Hodgkin lymphoma.
Researchers noted that increasing Medicaid coverage may facilitate access to guideline-based palliative care.
Disclosure: For full disclosures of the study authors, visit ascopubs.org.
