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. 2020 Apr 1;3(4):e203277.
doi: 10.1001/jamanetworkopen.2020.3277.

Association of Medicaid Insurance With Survival Among Patients With Small Cell Lung Cancer

Todd A Pezzi  1 , David L Schwartz  1   2 , Katherine M W Pisters  3 , Abdallah S R Mohamed  1 , James W Welsh  1 , Joe Y Chang  1 , Zhongxing Liao  1 , Saumil J Gandhi  1 , Lauren A Byers  3 , Bruce D Minsky  1 , Clifton D Fuller  1 , Stephen G Chun  1
Affiliations

Association of Medicaid Insurance With Survival Among Patients With Small Cell Lung Cancer

Todd A Pezzi et al. JAMA Netw Open. .

Abstract

Importance: Small cell lung cancer (SCLC) is an aggressive neoplasm requiring rapid access to subspecialized multidisciplinary care. For this reason, insurance coverage such as Medicaid may be associated with oncologic outcomes in this disproportionately economically vulnerable population. With Medicaid expansion under the Affordable Care Act, it is important to understand outcomes associated with Medicaid coverage among patients with SCLC.

Objective: To determine the association of Medicaid coverage with survival compared with other insurance statuses.

Design, setting, and participants: This cohort study included adult patients with limited-stage (LS) and extensive-stage (ES) SCLC in the US National Cancer Database from 2004 to 2013. Data were analyzed in January 2019.

Main outcomes and measures: Patients were analyzed with respect to insurance status. Associations of insurance status with survival were interrogated with univariate analyses, multivariable analyses, and propensity score matching.

Results: A total of 181 784 patients with SCLC (93 131 [51.2%] female; median [interquartile range] age; 67 [60-75] years for patients with LS-SCLC and 68 [60-75] years for patients with ES-SCLC) were identified, of whom 70 247 (38.6%) had LS-SCLC and 109 479 (60.2%) had ES-SCLC. On univariate analyses of patients with LS-SCLC, Medicaid coverage was not associated with a survival advantage compared with being uninsured (hazard ratio, 1.02; 95% CI, 0.96-1.08; P = .49). Likewise, on multivariable analyses of patients with ES-SCLC, compared with being uninsured, Medicaid coverage was not associated with a survival advantage (hazard ratio, 1.00; 95% CI, 0.96-1.03; P = .78). After propensity score matching, median survival was similar between the uninsured and Medicaid groups both among patients with LS-SCLC (14.4 vs 14.1 months; hazard ratio, 1.05; 95% CI, 0.98-1.12; P = .17) and those with ES-SCLC (6.3 vs 6.4 months; hazard ratio, 1.00; 95% CI, 0.96-1.04; P = .92).

Conclusions and relevance: Despite of billions of dollars in annual federal and state spending, Medicaid was not associated with improved survival in patients with SCLC compared with being uninsured in the US National Cancer Database. These findings suggest that there are substantial outcome inequalities for SCLC relevant to the policy debate on the Medicaid expansion under the Affordable Care Act.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Welsh reported serving on the scientific advisory boards of RefleXion Medical, MolecularMatch, Mavupharma, OncoResponse, and Checkmate; being a founder of Healios Oncology, MolecularMatch, and OncoResponse; receiving research and clinical trial support from Bristol-Myers Squibb; and receiving research support from Merck, Aileron, Nanobiotix, Mavupharma, and Checkmate. Dr Chang reported receiving research support from Bristol-Myers Squibb, serving as consultant for Astra Zeneca, receiving honoraria from Varian Medical Systems, and being a Shareholder of Global Oncology One, Inc. Dr Gandhi reported receiving scientific advisory board fees from Novocure, research grants from Bristol-Myers Squibb, and research grants from AstraZeneca outside the submitted work. Dr Byers reported receiving research funds and serving as an advisor or consultant for AstraZeneca, Abbvie, GenMab, PharmaMar, and Sierra Oncology; receiving research funds from Tolero Pharmaceuticals; and serving as an advisor or consultant for Bristol-Myers Squibb, Alethia, Merck, and Pfizer. Dr Fuller reported receiving direct industry grant support and travel funding from Elekta AB outside the submitted work. Dr Chun reported being a consultant for AstraZeneca. No other disclosures were reported.

Figures

Figure.
Figure.. Kaplan-Meier Curves for Overall Survival of Patients With Small Cell Lung Cancer After Propensity Score Matching
Graphs show overall survival curves for propensity score–matched cohorts of patients with limited-stage small cell lung cancer (A) and extensive-stage small cell lung cancer (B).
See this image and copyright information in PMC

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References

    1. Govindan R, Page N, Morgensztern D, et al. . Changing epidemiology of small-cell lung cancer in the United States over the last 30 years: analysis of the surveillance, epidemiologic, and end results database. J Clin Oncol. 2006;24(28):-. doi:10.1200/JCO.2005.04.4859 - DOI - PubMed
    1. Pignon JP, Arriagada R, Ihde DC, et al. . A meta-analysis of thoracic radiotherapy for small-cell lung cancer. N Engl J Med. 1992;327(23):1618-1624. doi:10.1056/NEJM199212033272302 - DOI - PubMed
    1. Agra Y, Pelayo M, Sacristán M, Sacristán A, Serra C, Bonfill X. Chemotherapy versus best supportive care for extensive small cell lung cancer. Cochrane Database Syst Rev. 2003;(4):CD001990. doi:10.1002/14651858.CD001990 - DOI - PubMed
    1. Slotman BJ, van Tinteren H, Praag JO, et al. . Use of thoracic radiotherapy for extensive stage small-cell lung cancer: a phase 3 randomised controlled trial. Lancet. 2015;385(9962):36-42. doi:10.1016/S0140-6736(14)61085-0 - DOI - PubMed
    1. Horn L, Mansfield AS, Szczęsna A, et al. ; IMpower133 Study Group . First-line atezolizumab plus chemotherapy in extensive-stage small-cell lung cancer. N Engl J Med. 2018;379(23):2220-2229. doi:10.1056/NEJMoa1809064 - DOI - PubMed

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