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Background <p>Studies show that Medicaid expansion leads to timely diagnosis and treatment of early-stage breast cancer; however, no studies have examined its impact on locally advanced breast cancer (LABC). We assessed LABC rates pre- and post-Medicaid expansion, and evaluated overall survival (OS) in LABC patients treated in expansion and non-expansion states.</p> Methods <p>Overall, 5147 National Cancer Database participants age 40–64&#xa0;years diagnosed with LABC between 2010 and 2017 were allocated into the two cohorts. Demographic/clinical variables were compared using the Wilcoxon rank-sum and Pearson’s Chi-square tests. A generalized linear model assessed trends in LABC diagnoses over time, while a Cox proportional hazards model evaluated associations between Medicaid expansion status and OS.</p> Results <p>A total of 3346 and 1801 LABC patients resided in expansion and non-expansion states, respectively. Ninety-one percent of non-expansion patients resided in the Southern United States (<i>p </i>&lt; 0.001) versus 8.2% of expansion patients. Non-expansion patients were more likely to be non-Hispanic Black and/or have lower income (<i>p </i>&lt; 0.001), while expansion patients were more likely to be Asian/Pacific Islander, Hispanic, metropolitan-area residents, and/or academic/research program-treated (<i>p </i>&lt; 0.001). Trimodality therapy use was similarly low between non-expansion and expansion patients (68% and 70%, respectively; <i>p </i>= 0.054), while OS improved in expansion versus non-expansion patients post-policy implementation (<i>p </i>&lt; 0.001). On multivariable analysis, triple-negative subtype (<i>p </i>&lt; 0.001) and residence in a non-expansion state (<i>p </i>= 0.015) were associated with worse survival, while receipt of trimodality therapy (<i>p </i>&lt; 0.001) was associated with improved survival.</p> Conclusions <p>While trimodality therapy was associated with improved survival, less than three-quarters of patients received this treatment in both state types. Medicaid expansion was associated with improved OS in the post-implementation era, suggesting that these changes in Medicaid coverage may positively impact LABC outcomes.</p>

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Medicaid Expansion Is Associated with Lower Mortality in Patients with Locally Advanced Breast Cancer

  • 期刊论文

  • 发表日期：

    2025年7月30日

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  • Simran Malhotra,
  • Daniel X. Choi,
  • Varadan Sevilimedu,
  • Rachel A. Greenup,
  • Audree B. Tadros

摘要

Background

Studies show that Medicaid expansion leads to timely diagnosis and treatment of early-stage breast cancer; however, no studies have examined its impact on locally advanced breast cancer (LABC). We assessed LABC rates pre- and post-Medicaid expansion, and evaluated overall survival (OS) in LABC patients treated in expansion and non-expansion states.

Methods

Overall, 5147 National Cancer Database participants age 40–64 years diagnosed with LABC between 2010 and 2017 were allocated into the two cohorts. Demographic/clinical variables were compared using the Wilcoxon rank-sum and Pearson’s Chi-square tests. A generalized linear model assessed trends in LABC diagnoses over time, while a Cox proportional hazards model evaluated associations between Medicaid expansion status and OS.

Results

A total of 3346 and 1801 LABC patients resided in expansion and non-expansion states, respectively. Ninety-one percent of non-expansion patients resided in the Southern United States (p < 0.001) versus 8.2% of expansion patients. Non-expansion patients were more likely to be non-Hispanic Black and/or have lower income (p < 0.001), while expansion patients were more likely to be Asian/Pacific Islander, Hispanic, metropolitan-area residents, and/or academic/research program-treated (p < 0.001). Trimodality therapy use was similarly low between non-expansion and expansion patients (68% and 70%, respectively; p = 0.054), while OS improved in expansion versus non-expansion patients post-policy implementation (p < 0.001). On multivariable analysis, triple-negative subtype (p < 0.001) and residence in a non-expansion state (p = 0.015) were associated with worse survival, while receipt of trimodality therapy (p < 0.001) was associated with improved survival.

Conclusions

While trimodality therapy was associated with improved survival, less than three-quarters of patients received this treatment in both state types. Medicaid expansion was associated with improved OS in the post-implementation era, suggesting that these changes in Medicaid coverage may positively impact LABC outcomes.