Associations of Early Medicaid Expansion With Insurance Status and Stage at Diagnosis Among Cancer Patients Receiving Radiation Therapy.

PURPOSE: Medicaid expansion in 2014 is associated with improved insurance coverage and stage at diagnosis in cancer patients. However, little is known about the effect of early Medicaid expansions in 2010 to 2011 on outcomes in radiation therapy recipients. The objective of this study was to estimate the effect of early Medicaid expansion on insurance status and stage at diagnosis among radiation therapy recipients. METHODS AND MATERIALS: The Surveillance, Epidemiology, and End Results database was queried for cases aged 18 to 64 diagnosed in 2007 to 2013 with a first primary malignancy treated with radiation therapy. Difference-in-differences analyses were used to compare changes in insurance coverage and stage at diagnosis from 2007 to 2009 and 2011 to 2013 in expansion relative to nonexpansion states. RESULTS: There was a -0.48 (95% confidence interval [CI], -0.84 to -0.13; P = .007) percentage point (PP) reduction in uninsured in expansion relative to nonexpansion states, primarily among counties with lower educational attainment (-1.73 PP; 95% CI, -2.72 to -0.75). Increases in early stage diagnoses in expansion relative to nonexpansion states were found overall and in breast (1.56 PP; 95% CI, 0.45-2.68; P = .006), colorectal (3.72 PP; 95% CI, 0.33-7.12; P = .032), and lung (1.49 PP; 95% CI, 0.25-2.72; P = .018) cancers. Decreases in late stage diagnoses were found in cervical (-5.91 PP; 95% CI, -9.58 to -2.25; P = .002), colorectal (-2.72 PP; 95% CI, -5.43 to -0.01; P = .05), and lung (-3.28 PP; 95% CI, -5.47 to -1.1; P = .003) cancers. CONCLUSIONS: For radiation therapy recipients, early Medicaid expansion was associated with decreased percent uninsured, particularly among low education counties, and earlier stage diagnoses for screenable cancers. Thus, early Medicaid expansion may improve access to care and decrease disparities for radiation therapy recipients.

Assessment of the treatment approach and survival outcomes in a modern cohort of patients with atypical teratoid rhabdoid tumors using the National Cancer Database.

BACKGROUND: Atypical teratoid rhabdoid tumors (ATRTs) are rare brain tumors that occur primarily in children under the age of 3 years. This report evaluates the treatment approach and survival outcomes in a large cohort of patients treated in the United States. METHODS: Using the National Cancer Database, the analysis included all ATRT patients aged 0 to 18 years who were diagnosed between 2004 and 2012 and had complete treatment data. RESULTS: Three hundred sixty-one ATRT patients were evaluated. The 5-year overall survival (OS) rate was 29.9%, and it was significantly lower for children who were less than 3 years old (5-year OS, 27.7%) versus those who were 3 years old or older (5-year OS, 37.5%; P < .001). The best outcome was seen for patients with localized disease who received trimodality therapy (surgery, chemotherapy, and radiation therapy [RT]) with a 5-year OS rate of 46.8%. The utilization of trimodality therapy significantly increased during the study period (27.7% in 2004-2008 vs 45.1% in 2009-2012; P < .01), largely because of the increased use of RT. In a multivariate analysis, treatment that did not utilize trimodality therapy was associated with significantly worse OS (hazard ratio, 2.52; 95% confidence interval (1.82-3.51). Children aged 0 to 2 years were significantly less likely to receive trimodality therapy because of decreased utilization of RT in this age group. CONCLUSIONS: The use of trimodality therapy significantly increased during the study period and was associated with improved outcomes. For patients with localized disease who received trimodality therapy, the OS rate at 5 years approached 50%. However, further research into the optimal management of children less than 3 years old is needed because of their significantly worse OS in comparison with older children. Cancer 2017;123:682-687. © 2016 American Cancer Society.