CHICAGO — The expansion of Medicaid under the Affordable Care Act in 2010 nearly erased a key disparity in access to cancer care for white and African-American patients, according to a new study.
The American Society of Clinical Oncology chose the study for prime placement this weekend at the plenary session of its annual meeting, the world’s largest gathering of cancer doctors, squeezing it in between studies of state-of-the-art cancer drugs in a statement about the importance of health insurance in determining how well cancer patients are treated.
“If you can’t access care you can’t benefit from care,” said Dr. Richard L. Schilsky, the society’s chief medical officer. “For all the advances we’ve observed in recent years in cancer treatment, in cancer care broadly speaking, if you don’t have insurance, if you can’t access care, if you can’t get care in a timely fashion, you can’t benefit.”
The new findings are striking. The study compared 18,678 patients who were treated for cancer either before states expanded the number of people who could receive Medicaid benefits under the ACA, or in states that chose not to expand Medicaid, to 11,708 patients who were treated in states that did expand Medicaid.
Without Medicaid expansion, white patients received chemotherapy within a month of their cancer diagnosis 48.3% of the time. But African-American patients received chemotherapy within a month 43.5% of the time, 4.8-point difference.
In states where Medicaid was expanded, this 4.8-point difference decreased to 0.8 points, a difference that was not statistically significant. In white patients, the Medicaid expansion increased the percent of patients who received chemotherapy in a month by two points; among African- Americans, there was a six-point change.
Chemotherapy isn’t the right first option for every patient, but the rates at which patients receive it promptly should be the same. “If you’re the same stage of diagnosis, same age, seen in the same practice, at the same time, there should be no reason why a black patient or a white patient should have a different time to treatment,” said Blythe Adamson, the study’s lead author and a researcher at Flatiron Health, a New York tech startup that was purchased by the Swiss drug giant Roche last year for $1.9 billion.
Amy Davidoff, the senior author on the paper and a researcher at the Yale School of Public Health, emphasized that the study didn’t and couldn’t correct for the economic status of individual patients, nor could it tell which patients received Medicaid. The change is a snapshot of all white and African-American patients who were in Flatiron’s database.
Among other reasons, the study is important because it highlights a new way of collecting data about cancer patients. Researchers at Flatiron laboriously read patient records in electronic medical records in order to extract useful data.
“This study is a major step forward in developing our understanding of this complex issue so we can identify solutions to address it,” said Dr. William Dale, a clinical professor in at City of Hope in Duarte, California, said in a statement release prepared by ASCO.
Adamson, the Flatiron researcher, moved across the country from the Fred Hutchison Cancer Research Center in order to join the company and get access to its data. She said she wanted to be “one of the first to really understand how to use this massive amount of real-world data to understand the value of medical interventions.”
Flatiron has data from 2.2 million people diagnosed with cancer who received care at 280 cancer clinics or academic medical centers. The company pays workers to read through the text charts of electronic medical records so that they can determine measures such as when patients start treatment or when tumors grow, which are not always marked clearly by doctors in current systems. The resulting data have been of great interest to drug companies, because they can provide information about how well medicines are working and in some instances may be able to replace expensive and time-consuming clinical trials.
ASCO also highlighted two other studies related to the effect of insurance on care on Sunday at a press conference. One showed that women were diagnosed with ovarian cancer sooner after the ACA went into effect. Overall, the percentage of women diagnosed with early-stage ovarian cancer increased 1.7%, which would translate to 400 women being diagnosed at a stage when the disease is more treatable.
Another study documented several ways that higher incomes and better insurance determine the outcomes of people with multiple myeloma, a blood cancer. Patients treated at academic medical centers had a 49% greater probability of survival. Those from areas with higher regional incomes had 16% greater chance of survival compared to those from lower-income areas. And people with private insurance had a 59% greater chance of survival than those who were insured through Medicaid.
Schilsky said that ASCO chose to present the research efforts together to reporters because they tell a story about the importance of health insurance for cancer patients in the United States.
“ASCO has not taken a stance on any healthcare plan advanced in Congress, including the ACA, but we have been critical of anything that does not adhere to ASCO’s core principles,” Schilsky said. “The data presented here underscore the importance of health insurance as a key driver to access to care, to timely diagnosis and treatment and hopefully better outcomes for patients.”