Earlier ovarian cancer diagnosis, treatment among impacts of Affordable Care Act
CHICAGO — Women with ovarian cancer appeared more likely to be diagnosed at an early stage and receive treatment within 30 days of diagnosis following implementation of the Affordable Care Act in 2010, according to results of a retrospective analysis presented at ASCO Annual Meeting.
Because early diagnosis and treatment play a critical role in ovarian cancer survival, the impact of the ACA on this patient population may be long term, researchers noted.
“Ovarian cancer is the deadliest of all the gynecologic malignancies,” Anna Jo Smith, MD, MPH, MSc, resident at Johns Hopkins University, said during the presentation. “Around 22,000 women are diagnosed every year in the United States, and more than half of them will be dead within 5 years of the diagnosis because most women present at late stages. We have no screening for ovarian cancer.”
Smith and colleagues conducted this study to evaluate the ACA’s impact on the stage at diagnosis and time to treatment among women with ovarian cancer. The researchers used a difference-in-differences (DD) approach to assess changes in these factors before and after passage of the ACA among women aged 21 to 64 years compared with women aged 65 years or older. The older group, which had Medicare access and thus a much lower risk for being uninsured during either period, served as a control group.
The pre-reform years (2004-2009) included data on 35,842 women aged 21 to 64 years and 28,895 women aged 65 or older, whereas the post-reform years (2011-2014) included 37,145 women aged 21 to 64 years and 30,604 women aged 65 years or older.
Researchers analyzed outcomes overall as well as by insurance type and adjusted for race, rural residency, neighborhood household income, education level, distance traveled for care, Charlson comorbidity score, census region and care at an academic center.
Results showed an association between the ACA and increased early-stage diagnosis among women aged 24 to 61 years compared with women aged 65 years and older (DD = 1.7%; P for trend = .001). Smith noted that this means nearly 400 women could be diagnosed at a treatable stage and have a better chance of longer survival.
Additionally, the ACA appeared associated with more women receiving treatment within 30 days of ovarian cancer diagnosis (DD = 1.6%; P < .001). Specifically, among women with public insurance, the ACA was associated with a significant improvement in early-stage diagnosis (DD = 2.5%; P = .003) and receipt of treatment within 30 days of diagnosis (DD = 2.5%; P = .006). Improvements in stage at diagnosis and time to treatment were seen across racial, income and education groups.
“Under the 2010 Affordable Care Act, women with ovarian cancer were more likely to be diagnosed at an earlier stage and receive treatment within 30 days of diagnosis,” Smith said. “As stage and treatment are major determinants of survival, these gains under the ACA may have long-term impacts on women with ovarian cancer.” – by John DeRosier
Smith AJ, et al. Abstract LBA5563. Presented at: ASCO Annual Meeting; May 31-June 4, 2019; Chicago.
Disclosures: The authors report no relevant financial disclosures.