Medicaid Expansion Prevents Gaps in Timely Start to Cancer Treatment Between Black and White People

Racial differences in time to starting cancer treatment disappear under ACA
ASCO Coverage
June 3, 2019
By: 
Eric Fitzsimmons, Copy Editor and Content Coordinator

A featured study at 2019 ASCO Annual Meeting showed one way Medicaidinfo-icon expansion has lessened the differences in care between black and white people with cancer. The expansion was part of the Patient Protection and Affordable Care Act, also known as ACA or Obamacare.

The study looked at time between diagnosisinfo-icon and start of cancer treatment among those diagnosed with advanced or metastaticinfo-icon cancers. The researchers wanted to test whether Medicaid expansion reduced the differences between white and black people in getting timely treatment after diagnosis.

Background

An ACA program allowed the federal government to give states funding to extend Medicaid to all adults who make less than a certain income.

Differences in care and outcomes between white and black people with cancer are well studied and happen throughout cancer care. Black people with breast cancer have 10 percent worse outcomes than white people with breast cancer.

This study looked at how the change in healthcare policy could affect one part of this problem, time between diagnosis and start of treatment. Researchers pointed out that while time to treatment often isn’t a pressing concern in individual cases, when examined across large groups, a longer period between diagnosis and care is associated with worse outcomes.

Included were people ages 18 through 64 diagnosed with advanced or metastatic solid tumors (such as breast, non-small-cellinfo-icon lung, and prostate) from January 2011 to January 2019 in states that expanded Medicaid access under the ACA. Treatment was considered timely if started within one month of diagnosis.

Results

Before Medicaid expansion

  • 48.3 percent of white people started treatment within a month of being diagnosed
  • 43.5 percent of black people started treatment within a month of being diagnosed

The results show that black people got a timely start to treatment at a rate 4.8 percentage points lower than white people.

Researchers then looked at the rates after Medicaid expansion and found

  • 50.3 percent of white people diagnosed started treatment within a month
  • 49.6 percent of black people diagnosed started treatment within a month

After Medicaid expansion, both black and white people were more likely to start treatment within a month. Looking across both groups, the increase was not statistically significantinfo-icon, meaning the change could have happened by chance. But when black and white people were compared to one another, black people had the most increased benefit, with 6.9 percent improvement for black people versus 1.8 percent for white people.

There are limitations to this study. It is observational, meaning it looked at existing data. Observational studies cannot prove whether one factor causes the effect. Such studies can only find an association, a relationship between the factor and the effect. This study also chose only one aspect of care – time to treatment – and did not look at outcomes.

What This Means for You

ASCO doesn’t often feature observational studies, but these findings help us understand how people get care outside of clinicalinfo-icon trials. The study identified one way that care is not applied equally for black and white people and showed that healthcare policy can change that. Not only did the difference between black and white people getting timely treatment go away, but both groups were more likely to start treatment sooner.

The study also shows how data can be used to help underserved populations. Yousuf Zafar, MD, a medical oncologistinfo-icon and health researcher from Duke University School of Medicineinfo-icon who provided commentary on the study, noted that even in countries with universal healthcare coverage, people from poorer backgrounds still have worse outcomes. Part of that difference may be explained by the lack of data on how care is given outside clinical trials.

This study should change how we look at cancer care and research, Dr. Zafar said. In the short-term, doctors should check the ways their practices may feed into differences in care. In the long-term, there are opportunities to provide better care for more people that don’t require new medicines.

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