The following article features coverage from the American Society of Clinical Oncology 2019 meeting. Click here to read more of Cancer Therapy Advisor‘s conference coverage.

The expansion of Medicaid was found to correlate with a reduction in racial disparities when looking at the timeliness of treatment between black and white patients, according to findings presented in the plenary session at the 2019 American Society of Clinical Oncology (ASCO) Annual Meeting.

Racial disparities in both cancer care and patient outcomes are known to exist across multiple elements of oncology treatment, explained presenter and study author Amy Davidoff, PhD, MS, of Yale University in New Haven, Connecticut. Further, timely and patient-centered oncology treatment is understood to improve clinical outcomes for patients, reduce patient anxiety, and is likely to create a better patient experience.

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The retrospective, observational findings focused on timeliness of treatment in patients with advanced or metastatic cancer being treated with systemic therapy. “One potential mechanism to reduce treatment disparities is to improve access to insurance coverage,” Dr Davidoff explained. After the signing of the Affordable Care Act (ACA), states were allowed to expand Medicaid coverage and a marketplace for private insurance offered with an income-based premium and out-of-pocket subsidies was established.

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The researchers hypothesized that the expansion of Medicaid would reduce disparity in time to treatment of black patients compared with white patients with advanced cancer.

To determine whether their hypothesis was accurate, the researchers reviewed data from a Flatiron Health-derived electronic health record database from January 2011 to January 2019 and data from the Kaiser Family Foundation and the US Bureau of Labor Statistics. Adult patients aged between 18 and 64 years who had been diagnosed with advanced or metastatic cancer were included.

Using these data, the researchers examined the experience of black patients compared with white patients who received treatment in states after the Medicaid expansion, to patients before the Medicaid expansion or to patients in states who had not expanded Medicaid by 2019.

Ultimately, the researchers found that in states where Medicaid was not expanded, black patients were 4.8 percentage points less likely to receive timely treatment (P <.001). In states where Medicaid was expanded, however, black patients were 0.8 percentage points less likely to receive timely treatment, which was no longer a statistically significant difference (P =.63).

The patient population for the study was 30,386, with 18,678 patients in the unexpanded Medicaid arm and 11,708 in the expanded Medicaid arm. Patients included in the study across both arms had non-small cell lung cancer (35%), colorectal cancer (21%), breast cancer (21%), gastric/esophageal cancers (6.4%), renal cell carcinoma (5.6%), melanoma (4.1%), prostate cancer (3.8%), and urothelial cancer (3.1%).

Dr Davidoff highlighted that these findings are not that of a randomized clinical trial, which limits the researcher’s ability to prove causality ― that is, they cannot directly link the expansion of Medicaid to timely treatment and thus, another undiscovered factor may be influencing these findings. She also pointed out that there is the potential for misclassification of timely treatment endpoint and the time treatment outcome was not linked to measured patient outcomes, such as survival or quality of life.

“Let’s address the elephant in the room,” commented Yousuf Zafar, MD, MHS, FASCO, of the Duke Cancer Institute, during a discussion of the abstract. “This is a nontraditional study to be presented at an ASCO plenary and I commend the committee for its selection.” Dr Zafar went on to state that these findings are practice changing and they serve as proof that health policy can affect cancer care quality and diminish racial disparities. Dr Zafar also highlighted the way in which these findings promote the use and sharing of real-world evidence to identify solutions that improve care quality and outcomes and urged audience members to consider these findings in their clinic as soon as “tomorrow” by sharing data, instituting patient navigation, and engaging with and advocating for all patients.

“Quality of cancer care has room for improvement and it’s possible that the path to improvement is paved with real-world evidence, which can identify policy solutions to improve care, quality, and outcomes,” Dr Zafar concluded.

Read more of Cancer Therapy Advisor‘s coverage of ASCO’s annual meeting by visiting the conference page.


Adamson BJS, Cohen AB, Estevez M, et al. Affordable Care Act (ACA) Medicaid expansion impact on racial disparities in time to cancer treatment. Presented at: 2019 American Society of Clinical Oncology (ASCO) Annual Meeting; May 31-June 4, 2019; Chicago, IL. Abstract LBA1.