Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA.
Department of Surgery, Federal University of Minas Gerais School of Medicine, Belo Horizonte, Brazil.
J Surg Oncol. 2024 Feb;129(2):233-243. doi: 10.1002/jso.27478. Epub 2023 Oct 5.
The impact of Medicaid expansion (ME) on the treatment of patients with cancer remains controversial, especially individuals requiring complex multidisciplinary care. We sought to evaluate the impact of Medicaid expansion (ME) on receipt of multimodal care, including surgical resection, for Stage I-III biliary tract cancer (BTC).
Patients diagnosed with BTC between 40 and 65 years of age were identified from the National Cancer Database and divided into pre- (2008-2012) and post- (2015-2018) ME cohorts. Difference-in-difference (DID) analysis was used to determine the impact of ME on the utilization of surgery and multimodal chemotherapy and/or radiotherapy treatment for BTC.
Among 12,415 patients with BTC (extrahepatic, n = 5622, 45.3%; intrahepatic, n = 4352, 35.1%; gallbladder, n = 1944, 15.7%; overlapping, n = 497, 4.0%), 5835 (47.0%) and 6580 (53.0%) patients were diagnosed before versus after ME, respectively. Overall utilization of surgery (OR 1.13, 95% CI 1.02-1.26) and multimodality therapy (OR 1.13, 95% CI 1.01-1.27) increased in states that adopted ME. Utilization of surgery among uninsured/Medicaid patients in ME states increased relative to patients living in non-ME states (∆+10.1%, p = 0.01). Similarly, the use of multimodal treatment increased among uninsured/Medicaid patients living in ME versus non-ME states (∆+6.4%, p = 0.04); in contrast, there were no difference among patients with other insurance statuses (overall: ∆+1.5%, private: ∆-2.0%, other: ∆+3.9%, all p > 0.5). Uninsured/Medicaid patients with BTC who lived in a ME state had a lower risk of long-term death in the post-ME era (HR 0.81, 95% CI 0.67-0.98; p = 0.03).
Implementation of ME positively impacted survival among patients who underwent surgical and multimodal treatment for Stage I-III BTC.
医疗补助计划（Medicaid expansion，ME）对癌症患者治疗的影响仍存在争议，尤其是那些需要复杂多学科治疗的患者。我们旨在评估 ME 对包括手术切除在内的多模式治疗的接受情况，以治疗 I-III 期胆道癌（biliary tract cancer，BTC）患者。
从国家癌症数据库中确定了 40 至 65 岁之间被诊断为 BTC 的患者，并将其分为 ME 前（2008-2012 年）和 ME 后（2015-2018 年）队列。采用差异中的差异（Difference-in-difference，DID）分析来确定 ME 对 BTC 手术和多模式化疗和/或放疗治疗的利用情况的影响。
在 12415 例 BTC 患者（肝外胆管癌，n=5622，45.3%；肝内胆管癌，n=4352，35.1%；胆囊癌，n=1944，15.7%；重叠癌，n=497，4.0%）中，分别有 5835 例（47.0%）和 6580 例（53.0%）患者在 ME 前和 ME 后被诊断。接受手术（比值比，OR 1.13，95%置信区间，CI 1.02-1.26）和多模式治疗（OR 1.13，95%CI 1.01-1.27）的总体使用率在实施 ME 的州中有所增加。在 ME 州，接受手术的未参保/医疗补助患者的比例相对非 ME 州有所增加（∆+10.1%，p=0.01）。同样，在 ME 州接受多模式治疗的未参保/医疗补助患者比例也高于非 ME 州（∆+6.4%，p=0.04）；相比之下，其他保险状态的患者之间没有差异（总体：∆+1.5%，私人：∆-2.0%，其他：∆+3.9%，均 p>0.5）。在 ME 州居住的未参保/医疗补助的 BTC 患者在 ME 后时代的长期死亡风险较低（风险比，HR 0.81，95%CI 0.67-0.98；p=0.03）。
实施 ME 对接受 I-III 期 BTC 手术和多模式治疗的患者的生存产生了积极影响。
