Grutman Aurora J, Pavlovich Christian P
Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
James Buchanan Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Cancer. 2025 Dec 1;131(23):e70186. doi: 10.1002/cncr.70186.
The One Big Beautiful Bill Act (OBBBA), signed into law in July 2025, introduced sweeping changes to Medicaid financing. Although framed as measures intended to foster independence and fiscal sustainability, these policies risk destabilizing continuity of care for cancer patients. Prostate cancer patients represent a sizeable population that may be impacted by the OBBBA, as prostate cancer is the most commonly diagnosed cancer in men in the United States. Patients with favorable-risk prostate cancer who are managed through active surveillance may in particular be at risk of poor oncologic outcomes due to restructured health care financing. Active surveillance-an evidence-based strategy for managing early-stage prostate cancer-relies on regular monitoring with imaging, laboratory testing, and biopsies. Temporary insurance gaps or modest increases in out-of-pocket costs could disrupt adherence to surveillance schedules, resulting in delayed detection of cancer progression, avoidable overtreatment, or late-stage presentation. Sustainable Medicaid reform is essential, but policies that undermine evidence-based management can heighten disparities, increase long-term costs, and compromise survival in prostate cancer care. Without careful recalibration, the OBBBA risks widening disparities and reversing decades of progress in management of favorable-risk prostate cancer.
《一项重大美好法案》（OBBBA）于2025年7月签署成为法律，对医疗补助融资进行了全面改革。尽管这些政策被视为旨在促进独立性和财政可持续性的措施，但它们有可能破坏癌症患者的连续护理。前列腺癌患者是一个庞大的群体，可能会受到OBBBA的影响，因为前列腺癌是美国男性中最常被诊断出的癌症。通过主动监测进行管理的低风险前列腺癌患者尤其可能因医疗保健融资结构调整而面临不良肿瘤学结局的风险。主动监测——一种管理早期前列腺癌的循证策略——依赖于通过影像学、实验室检测和活检进行定期监测。临时保险缺口或自付费用的适度增加可能会扰乱对监测计划的依从性，导致癌症进展的检测延迟、可避免的过度治疗或晚期就诊。可持续的医疗补助改革至关重要，但破坏循证管理的政策可能会加剧差距、增加长期成本，并危及前列腺癌护理中的生存率。如果不进行仔细的重新校准，OBBBA有可能扩大差距，并扭转在低风险前列腺癌管理方面数十年来取得的进展。
