Medicaid Expansion Is Associated with Lower Mortality in Patients with Locally Advanced Breast Cancer Journal Article
| Authors: | Malhotra, S.; Choi, D. X.; Sevilimedu, V.; Greenup, R. A.; Tadros, A. B. |
| Article Title: | Medicaid Expansion Is Associated with Lower Mortality in Patients with Locally Advanced Breast Cancer |
| Abstract: | Background Studies show that Medicaid expansion leads to timely diagnosis and treatment of early-stage breast cancer; however, no studies have examined its impact on locally advanced breast cancer (LABC). We assessed LABC rates pre- and post-Medicaid expansion, and evaluated overall survival (OS) in LABC patients treated in expansion and non-expansion states. Methods Overall, 5147 National Cancer Database participants age 40-64 years diagnosed with LABC between 2010 and 2017 were allocated into the two cohorts. Demographic/clinical variables were compared using the Wilcoxon rank-sum and Pearson's Chi-square tests. A generalized linear model assessed trends in LABC diagnoses over time, while a Cox proportional hazards model evaluated associations between Medicaid expansion status and OS. Results A total of 3346 and 1801 LABC patients resided in expansion and non-expansion states, respectively. Ninety-one percent of non-expansion patients resided in the Southern United States (p < 0.001) versus 8.2% of expansion patients. Non-expansion patients were more likely to be non-Hispanic Black and/or have lower income (p < 0.001), while expansion patients were more likely to be Asian/Pacific Islander, Hispanic, metropolitan-area residents, and/or academic/research program-treated (p < 0.001). Trimodality therapy use was similarly low between non-expansion and expansion patients (68% and 70%, respectively; p = 0.054), while OS improved in expansion versus non-expansion patients post-policy implementation (p < 0.001). On multivariable analysis, triple-negative subtype (p < 0.001) and residence in a non-expansion state (p = 0.015) were associated with worse survival, while receipt of trimodality therapy (p < 0.001) was associated with improved survival. Conclusions While trimodality therapy was associated with improved survival, less than three-quarters of patients received this treatment in both state types. Medicaid expansion was associated with improved OS in the post-implementation era, suggesting that these changes in Medicaid coverage may positively impact LABC outcomes. |
| Keywords: | overall survival; breast cancer; medicaid; diagnosis; stage; care; disparities; locally advanced breast cancer; breast cancer mortality; medicaid expansion |
| Journal Title: | Annals of Surgical Oncology |
| ISSN: | 1068-9265 |
| Publisher: | Springer |
| Publication status: | Online ahead of print |
| Date Published: | 2025-01-01 |
| Online Publication Date: | 2025-01-01 |
| Language: | English |
| ACCESSION: | WOS:001541031200001 |
| DOI: | 10.1245/s10434-025-17865-x |
| PROVIDER: | wos |
| Notes: | Article; Early Access -- Source: Wos |
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