Impact of affordable care act on the treatment and outcomes for stage-IV colorectal cancer

• Published in: Cancer treatment and research communications 2020, Vol.24, p.100204, Article 100204
• Main Authors: Jayakrishnan, Thejus T, Bakalov, Veli, Chahine, Zena, Finley, Gene, Monga, Dulabh, Wegner, Rodney E
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - diagnosis; Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adenocarcinoma - therapy; Affordable care act; African Americans - statistics & numerical data; Aged; Chemotherapy; Colonic Neoplasms - diagnosis; Colonic Neoplasms - mortality; Colonic Neoplasms - pathology; Colonic Neoplasms - therapy; Colorectal cancer; European Continental Ancestry Group - statistics & numerical data; Health policy; Health Services Accessibility - legislation & jurisprudence; Health Services Accessibility - statistics & numerical data; Health Services Accessibility - trends; Health Status Disparities; Healthcare Disparities - legislation & jurisprudence; Healthcare Disparities - statistics & numerical data; Hispanic Americans - statistics & numerical data; Humans; Insurance; Insurance Coverage - legislation & jurisprudence; Insurance Coverage - statistics & numerical data; Kaplan-Meier Estimate; Medicaid; Medicaid - statistics & numerical data; Medicare; Middle Aged; Neoplasm Staging; Patient Protection and Affordable Care Act; Rectal Neoplasms - diagnosis; Rectal Neoplasms - mortality; Rectal Neoplasms - pathology; Rectal Neoplasms - therapy; Retrospective Studies; Social determinants; Socioeconomic Factors; Survival; Time-to-Treatment - statistics & numerical data; United States - epidemiology
• ISSN: 2468-2942; 2468-2942
• DOI: 10.1016/j.ctarc.2020.100204

•Racial status (Non hispanic black race) was a significant predictor for therapy enrollment and mortality outcome but showed variation with respect to ACA.•For metastatic colon cancer, the impact on mortality improved post-ACA. For metastatic rectal cancer, the enrollment to therapies improved but negative impact on mortality persisted.•The Affordable Care Act appears to have had a positive impact overall but more needs to be done. Further research is warranted given limitations of the study design. Patients with advanced cancers are among the most vulnerable group of patients. We sought to analyze the impact of Affordable Care Act (ACA) on the interaction of socioeconomic factors with treatment and survival in patients with metastatic colorectal cancers. National Cancer Database (NCDB) was queried for patients with Stage-IV colon(CCa) and rectal cancers(R-Ca) diagnosed 2004–2015 and excluded those who did not receive any therapies within 6 months of diagnosis. Enrollment-rates were calculated as receipt of primary therapy as the incident-event (numerator) over time-to-initiation of therapy (denominator) and used to calculate incident-rate ratios that was analyzed using Poisson regression analysis- reported as enrollment-rate ratios (ER,