Patients treated for biliary tract cancer who lived in states with expanded Medicare showed improved treatment outcomes.
In states with expanded Medicaid (ME), patients treated for biliary tract cancer received more care and lived longer, researchers report in Journal of Surgical Oncology.
“Our study showed that policies like ME can meaningfully impact patient care,” says lead study author Timothy M. Pawlik, MD, PhD, MPH.
“Governmental policies such as the Affordable Care Act and Medicare expansion had an impact on receipt of multimodality care for stage I‐III biliary tract cancers, including surgical resection, and it led to better outcomes for patients. This was most pronounced in patients who were uninsured or on Medicaid,” he adds. “Patients who lived in states that adopted ME had a roughly 13% higher chance of undergoing surgery and of receiving multimodal treatment for their biliary tract cancer than did patients who lived in states that did not expand Medicaid.”
Dr. Pawlik and colleagues retrieved National Cancer Database data of patients aged between 40 and 65 years who were diagnosed with stage I‐III biliary tract cancers before ME (2008–2012) and compared them with those who were diagnosed during ME (2015–2018).
The researchers used difference‐in‐difference analysis to determine the impact of ME on the utilization of surgery, multimodal chemotherapy, and radiotherapy to treat biliary tract cancer.
Patients in ME States Received More Care and Lived Longer
Of the 12,415 patients with biliary tract cancers, 5,835 (47.0%) were diagnosed before ME and 6,580 (53.0%) were diagnosed after ME took effect.
In states that adopted ME, overall surgery utilization (odds ratio [OR], 1.13; 95% CI, 1.02-1.26) and multimodality therapy (OR, 1.13; 95% CI, 1.01-1.27) increased.
In ME states, surgery utilization increased 10.1% (P=0.01) and multimodal treatment increased 6.4% (P=0.04) among uninsured and Medicaid patients compared to utilization of patients living in non‐ME states. Uninsured and Medicaid patients with biliary tract cancer who lived in ME states also were at lower risk for long‐term death under ME (hazard ratio [HR], 0.81; 95% CI, 0.67-0.98; P=0.03). (Figure)
These results do not surprise Dr. Pawlik and coauthors. “Our group and others who have looked at the impact of ME have found similar results related to pancreatic, gastrointestinal, and other cancers,” he says.
“Governmental policies can meaningfully and directly impact access to care,” he adds. “However, while ME can increase access to care, many barriers to care—including transportation, access to food, poverty, psychological stress, health literacy, race and ethnicity, and language and other communication issues—remain.”
Doctors Need to Screen for Social Determinants of Health
“These social determinants of health are as important or more important for patients getting optimal healthcare outcomes,” Dr. Pawlik adds. “We frequently ask patients about their blood pressure, and whether they have diabetes. As health care providers, we need to have a broader notion of health and wellness. We should be asking our patients, ‘Do you have transportation to your next healthcare visit, do you have access to food, do you have problems paying your medical bills?’”
Dr. Pawlik recommends future research into policies to counteract the social determinants that impede access to cancer care.
“Only when we start asking these questions and start identifying some of the social barriers to health will we be able to target more precisely how we can address health care disparities and help patients get the care they need,” he concludes.
