4.5 Article

Medicaid expansion and the management of pancreatic cancer

Journal

JOURNAL OF SURGICAL ONCOLOGY
Volume 124, Issue 3, Pages 324-333

Publisher

WILEY
DOI: 10.1002/jso.26515

Keywords

health insurance; healthcare policy; Medicaid expansion; pancreatic cancer

Funding

  1. NCI NIH HHS [T32 CA113263] Funding Source: Medline

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Medicaid expansion has increased insurance coverage and early stage diagnoses for pancreatic cancer patients, but did not significantly impact surgical outcomes or overall survival. This study highlights both the benefits and limitations of policy changes in improving outcomes for aggressive malignancies like pancreatic cancer.
Background Medicaid expansion under the Affordable Care Act has improved access to screening and treatment for certain cancers. It is unclear how this policy has affected the diagnosis and management of pancreatic cancer. Methods Using a quasi-experimental difference-in-differences (DID) approach, we analyzed Medicaid and uninsured patients in the National Cancer Data Base during two time periods: pre-expansion (2011-2012) and postexpansion (2015-2016). We investigated changes in cancer staging, treatment decisions, and surgical outcomes. Results In this national cohort, pancreatic cancer patients in expansion states had increased Medicaid coverage relative to those in nonexpansion states (DID = 17.49, p < 0.01). Medicaid expansion also led to an increase in early-stage diagnoses (Stage I/II, DID = 4.71, p = 0.03), higher comorbidity scores among surgical patients (Charlson/Deyo score 0: DID = -13.69, p = 0.02), a trend toward more neoadjuvant radiation (DID = 6.15, p = 0.06), and more positive margins (DID = 11.69, p = 0.02). There were no differences in rates of surgery, postoperative outcomes, or overall survival. Conclusion Medicaid expansion was associated with improved insurance coverage and earlier stage diagnoses for Medicaid and uninsured pancreatic cancer patients, but similar surgical outcomes and overall survival. These findings highlight both the benefits of Medicaid expansion and the potential limitations of policy change to improve outcomes for such an aggressive malignancy.

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