December 19, 2019
2 min read

ACA leads to earlier diagnosis, better care for young adults with colorectal cancer

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Leticia Nogueira

The Affordable Care Act’s dependent coverage expansion provision has resulted in earlier-stage diagnosis and more timely receipt of adjuvant chemotherapy among young patients with colorectal cancer, according to results of a retrospective study published in Journal of the National Cancer Institute.

“Colorectal cancer is more common among older adults, but colorectal cancer incidence and mortality are increasing among young adults,” Leticia Nogueira, PhD, MPH, principal scientist in the surveillance and health services research program at American Cancer Society, told Healio. “Prior to the ACA, young adults were more likely to be uninsured than adults in other age groups. Health insurance coverage improves access to care, including early evaluation of symptoms. Lack of health insurance coverage is strongly associated with delaying or forgoing medical care.”

The dependent coverage expansion (DCE) provision of the ACA, which took effect in in 2010, allowed young adults up to age 26 years to remain covered by their parents’ health insurance policies. Historically, young adults had the highest uninsured rate in the United States.

Nogueira and colleagues sought to determine whether the ACA led to earlier diagnosis of colorectal cancer among young adults, as well as whether it improved access to care for young adults already diagnosed with the disease.

The researchers used the National Cancer Database to analyze 10,237 young adults diagnosed with colorectal cancer between 2007 and 2013, including 1,924 patients aged 19 to 25 years who were eligible under the DCE and 8,313 patients aged 27 to 34 years who were not eligible under the provision.

Results showed a 15 percentage-point increase in early diagnosis of colorectal cancer among DCE-eligible patients following implementation of the ACA (12.8% pre-ACA to 27.8% post-ACA; P < .001). The 4.4 percentage-point increase in early diagnosis among DCE-ineligible patients was not statistically significant.

The proportion of patients aged 19 to 25 years who had private insurance increased by 5.5 percentage points after implementation of the ACA.

Patients aged 19 to 25 years who underwent surgery for stage IIB or IIIC colorectal cancer appeared more likely to receive adjuvant chemotherapy post-ACA than pre-ACA (HR = 1.34; 95% CI, 1.05-1.71). Additionally, the restricted mean time from surgery to chemotherapy for these patients decreased from 57.4 days pre-ACA to 50.4 days post-ACA.

Patients ineligible under the DCE experienced no significant changes in rate or timing of adjuvant treatment (HR = 1.1; 95% CI, 0.98-1.24).


A lack of information on diagnostic pathway and reasons for any delays in receipt of adjuvant chemotherapy served as the study’s primary limitations.

“Historically, adults without health insurance coverage are less likely to have a usual source of primary care than their counterparts with insurance coverage,” Nogueira said. “If they are diagnosed with cancer, uninsured adults are more likely to have later-stage disease, less likely to receive recommended cancer treatment, and have worse survival. Ensuring that all adults have comprehensive health insurance coverage will improve access to care and lead to improved cancer outcomes.” – by John DeRosier

For more information:

Leticia Nogueira, PhD, MPH, can be reached at American Cancer Society, Inc., 250 Williams St., Atlanta, GA 30303; email:

Disclosures: The American Cancer Society funded this study. The researchers report no relevant financial disclosures.