Dr. Hoehn and his colleagues compared colon cancer data for 4,438 patients residing in 19 states that implemented expansion in January 2014 ("expansion states") with data for 6,017 patients in 19 "nonexpansion" states at that time. To estimate the relative effect of the expansion policy, they selected the years 2011-2012 to assess data before expansion and 2015-2016 for post-expansion data.
In statistical analyses between these periods, the investigators observed no significant differences between Medicaid expansion and nonexpansion states for postoperative outcomes such as hospital length of stay, readmission rates, and deaths. However, patients with colon cancer stages I to III did have differences in timeliness of care based on their state expansion category. In nonexpansion states, the days to treatment (primarily surgical) increased and the proportion of patients treated in less than 30 days decreased. Dr. Hoehn said they did not observe these delays in care in expansion states.
Other key differences in the 2015-2016 period were as follows:
A larger number of patients in expansion states received treatment at integrated network cancer programs accredited by the Commission on Cancer of the American College of Surgeons. Research evidence for other cancer types suggests these programs offer better overall survival rates.
Patients traveled farther for care in expansion states, suggesting that patients who lived greater distances from hospitals could now obtain care because of coverage, Dr. Hoehn noted.
Patients in expansion states who had end-stage colon cancer were more likely to receive palliative care services, which aim to improve quality of life.
Among patients who underwent cancer operations, more in expansion states had minimally invasive surgery and nonurgent operations. Dr. Hoehn said both changes may be due to earlier diagnosis in these states.
The reasons why patients in expansion states had more stage I diagnoses after expansion than before are unclear from the data but may point to better access to care, said senior investigator Samer T. Tohme, MD, surgical oncologist at UPMC Hillman Cancer Center and assistant professor of surgery at the University of Pittsburgh School of Medicine. He said their findings suggest that Medicaid expansion has enabled more previously uninsured people to see a primary care physician and get screened for colon cancer.
"Studies show that patients who are diagnosed with cancer at an earlier stage are more likely to have better treatment options, improved quality of care, and longer survival," Dr. Tohme said.
