ASCO GU 2018: Impact of Medicaid Expansion on Diagnosis and Management of Patients with Testicular Cancer

San Francisco, CA (UroToday.com) In this rapid fire abstract session, Dr. Shen presented their groups recent Surveillance Epidemiology and End Results (SEER) Database analysis. Previous studies have demonstrated that insurance status is a key determinant of cancer outcomes. The optional Medicaid expansion, starting in 2014, is a crucial aspect of the affordable care act passed in 2010. It is theorized that patients with testicular cancer specifically may derive particular benefit from the expansion act due to demographic overlap and younger age at diagnosis. Their hypothesis was that that this Medicaid expansion would lead to earlier diagnosis and more guideline concordant treatment of patients.

The SEER database was reviewed from 2010-2014 and stratified by states that utilized and did not utilize the expansion act. 2010-2013 was used as pre-expansion comparison. Interestingly, Dr. Shen noted that Medicaid enrollment increased by 30.4% from 2013-2014 in expansion states and by 8.4% in non-expansion states. In the expansion states, Medicaid coverage for testicular cancer increased from 14.8% to 19.4% in 2014 (p<0.001) and uninsured decreased from 8.7 to 4.3% (p<0.001). This differed from non-expansion states, where coverage with Medicaid (p=0.60) and uninsured (p=0.68) did not change. Within individual states a linear correlation was noted between increasing % in Medicaid enrollment and % decrease in uninsured.

Amongst Medicaid patients in expansion states, there was an increase in stage I cases (52% to 60%), but a decrease in stage III cases (27% to 20%). No changes among insured patients were seen for stage I (70.6% to 73.3%) and stage III (10.9% to 9.1%). In contrast to these findings, in non-Medicaid expansion states, Medicaid patients had decrease in stage I and increase in stage III cases. Medicaid patients had higher rates of no treatment and lower rates of lymph node assessment for stage II NSGCT compared to insured patients, but this did not vary with expansion states.

This study shows that the Medicaid expansion increased coverage for testicular cancer patients. The authors suggest that the expansion may have caused a stage migration to earlier stages of testicular cancer. This is hypothesis generating data but its impact of this on survival outcomes will likely need longer follow up as there is a data lag. Additionally, from this study, it is unclear which treatments the patients have received. Although this is population based data that may be impacted by confounding factors, a clear association is seen.

Speaker: Xinglei Shen, MD, Department of Radiation Oncology, University of Kansas Medical Center

Written by: David B. Cahn, DO, MBS, Fox Chase Cancer Center, Twitter: @dbcahn at the 2018 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, February 8-10, 2018 - San Francisco, CA
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