Patients with newly diagnosed hormone receptor–negative, HER2-positive breast cancer were more likely to receive timely, guideline-concordant treatment and experience longer survival in states participating in Medicaid expansion under the Affordable Care Act, according to a recent study published by Shi et al in JNCCN–Journal of the National Comprehensive Cancer Network.
Study Methods and Results
In the study, investigators used data from the National Cancer Database to review the outcomes of patients aged 18 to 62 years who were diagnosed with hormone receptor–negative, HER2-positive breast cancer in the United States between 2010 and 2018.
The investigators noted that 19,248 of the patients were residing in Medicaid-expansion states, whereas 12,153 of them resided in nonexpansion states. Compared with those residing in the nonexpansion states, the patients residing in the expansion states experienced an increase in the 2-year survival rate from 93.9% vs 94.0% in 2010 to 95.0% vs 93.9% in 2018. The greatest difference was observed in patients with stage III disease.
Further, the investigators found that treatment according to recommendations from evidence-based, expert-consensus driven clinical practice guidelines—such as the NCCN Clinical Practice Guidelines in Oncology®—was more likely to begin within 90 days of diagnosis in the Medicaid-expansion states.
Conclusions
“Expanding Medicaid to the 10 states that have yet to do so can help ensure that more patients with cancer benefit from life-saving treatments. It’s crucial to increase access to oncology services, expand insurance coverage, and streamline diagnostic and referral processes,” emphasized lead study author Kewei Sylvia Shi, MPH, of the Surveillance and Health Equity Science Department at the American Cancer Society. “Stage III cancer represents a critical point in disease presentation and can further progress and become incurable if undertreated. Having health insurance coverage will make it more likely for these patients to receive timely and comprehensive access to life-saving therapies, have better medication adherence, and complete treatment—which leads to better survival outcomes,” she indicated.
“This study reinforces the important role Medicaid expansion plays in ensuring that women newly diagnosed with [hormone receptor]–negative, HER2-positive breast cancer have equitable access to the health-care services they need—especially when prognosis depends on access to treatment,” underscored Millicent Gorham, PhD (Hon), MBA, FAAN, Chief Executive Officer of the Alliance for Women’s Health and Prevention, who was not involved in the research. “Breast cancer is far too common, and rates are increasing among younger women, making it critical that policymakers also prioritize women’s access to preventive health screenings and appropriate treatments,” she concluded.
Disclosure: For full disclosures of the study authors, visit jnccn.org.
