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Introduction <p>It is unknown whether underutilization of cancer-directed surgery (CDS) in patients with Medicaid contributes to worse overall survival (OS) across various operative risk spectrum in comparison to non-Medicaid patients.</p> Method <p>The SEER database linked to Medicaid enrollment files between 2006 and 2013 was used. Spectrum of operative risks included pancreatic ductal adenocarcinoma (PDAC)—high-risk, colon cancer (CC)—intermediate-risk, or melanoma—low-risk. Multivariable Cox proportional-hazard and logistic regression analyses were used.</p> Results <p>There were 7,595 Medicaid and 163,416 non-Medicaid patients. Being in Medicaid was associated with higher odds of not undergoing CDS for CC (OR 1.88, 95% CI 1.41–2.52) and PDAC (OR 2.20, 95% CI 1.73–2.80). Correspondingly, not undergoing CDS was associated with worse survival (CC—HR 4.76, 95% CI 3.82–5.93; PDAC—HR 2.40, 95% CI 2.21–2.60) in Medicaid group vs non-Medicaid group. For melanoma, there was a larger impact of not undergoing CDS on OS in Medicaid compared to non-Medicaid population (HR 1.75, 95% CI 1.07–2.89).</p> Conclusion <p>Across cancers with different operative risks, increasing the use of CDS may help reduce the OS gaps between Medicaid and non-Medicaid population.</p>

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Utilization of cancer-directed surgical therapy in Medicaid patients with cancer: comparison between low/intermediate/high-risk surgeries

  • 期刊论文

  • 发表日期：

    2025年5月22日

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  • Heenaben Patel,
  • Mohammad S. Ali,
  • Jae-Yong Ahn,
  • N. Joseph Espat,
  • Abdul S. Calvino,
  • Ponnandai Somasundar,
  • Steve Kwon

摘要

Introduction

It is unknown whether underutilization of cancer-directed surgery (CDS) in patients with Medicaid contributes to worse overall survival (OS) across various operative risk spectrum in comparison to non-Medicaid patients.

Method

The SEER database linked to Medicaid enrollment files between 2006 and 2013 was used. Spectrum of operative risks included pancreatic ductal adenocarcinoma (PDAC)—high-risk, colon cancer (CC)—intermediate-risk, or melanoma—low-risk. Multivariable Cox proportional-hazard and logistic regression analyses were used.

Results

There were 7,595 Medicaid and 163,416 non-Medicaid patients. Being in Medicaid was associated with higher odds of not undergoing CDS for CC (OR 1.88, 95% CI 1.41–2.52) and PDAC (OR 2.20, 95% CI 1.73–2.80). Correspondingly, not undergoing CDS was associated with worse survival (CC—HR 4.76, 95% CI 3.82–5.93; PDAC—HR 2.40, 95% CI 2.21–2.60) in Medicaid group vs non-Medicaid group. For melanoma, there was a larger impact of not undergoing CDS on OS in Medicaid compared to non-Medicaid population (HR 1.75, 95% CI 1.07–2.89).

Conclusion

Across cancers with different operative risks, increasing the use of CDS may help reduce the OS gaps between Medicaid and non-Medicaid population.