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Todd Pezzi



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    PD01 - Poster Discussion Session (ID 4)

    • Event: NACLC 2019
    • Type: Poster Discussion Session
    • Track:
    • Presentations: 1
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      PD01.21 - Medicaid Outcome Inequalities in Small Cell Lung Cancer (ID 9)

      15:45 - 16:45  |  Author(s): Todd Pezzi

      • Abstract

      Background:
      Small cell lung cancer (SCLC) is an aggressive malignancy for which early access to multidisciplinary care is crucial to optimize outcomes. For this reason, insurance coverage such as Medicaid may drive oncologic outcomes in this population. With the Medicaid expansion under the Affordable Care Act, it is meaningful to understand the value of the Medicaid program in disproportionately vulnerable populations such as SCLC.


      Method:
      Outcomes of SCLC in the United States National Cancer Database (NCDB) were analyzed from 2004-2013 with respect to baseline insurance status. Associations between insurance status and survival were interrogated using univariate analyses (UVA), multivariable analyses (MVA) and propensity score (PS) matching.


      Results:
      There were 181,784 cases of SCLC of which 38.6% were limited-stage (LS) and 60.2% extensive-stage (ES). In LS-SCLC, Medicaid coverage had similar survival as the uninsured on UVA (HR, 1.02; 95% CI, 0.96-1.08; p = 0.49). MVA showed factors associated with improved survival in LS-SCLC included private/managed care insurance (HR, 0.83; 95% CI 078-0.87; P < 0.001), Medicare insurance (HR 0.92; 95% CI 0.88-0.97; p = 0.002), chemotherapy delivery (HR, 0.62; 95% CI, 0.61-0.64, p < 0.001) and radiation therapy (HR, 142 0.61; 95% CI, 0.60-0.63, p < 0.001). Likewise, Medicaid coverage had no survival advantage in ES-SCLC compared to the uninsured on MVA (HR, 1.00; 95% CI 0.96-1.03, p = 0.78). Factors associated with improved survival in ES-SCLC on MVA included private/managed care (HR, 0.86; 95% CI, 0.83-0.89, p < 0.001), Medicare insurance (HR, 0.94; 95% CI, 0.91-0.97, p < 0.001), treatment at an academic/research program (HR, 0.93; 95% CI, 0.91-0.95; p < 0.001), and chemotherapy delivery (HR 0.40; 95% CI, 0.39-0.40; P < 0.001). After PS matching, median survival was similar between the uninsured and Medicaid groups in both LS-SCLC (14.4 vs. 14.1 months; p = 0.167) and ES-SCLC (6.3 vs 6.4 months; p = 0.918).


      Conclusion:
      Despite billions of dollars in annual Federal/State funding, Medicaid coverage had no discernable impact on survival in SCLC compared to the uninsured in the United States NCDB. These sobering findings reveal the SCLC population to be a specific healthcare policy target for intervention relevant to the debate on the Medicaid expansion under the Affordable Care Act.