ACA has improved cancer care, clinical trial access among Hispanics

The proportion of Hispanic women with breast cancer who presented at an NCI–designated cancer center and enrolled in a clinical trial significantly increased following the implementation of the Affordable Care Act, according to study results presented at the AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved.

This suggests the Affordable Care Act (ACA) may lead to greater access to NCI–designated cancer centers that are not located in or near underserved communities among previously uninsured patients, according to the researchers.

“Our study shows that with the implementation of the ACA in California, our cancer center’s Hispanic breast cancer patient population increased significantly,” Chloe Lalonde, clinical research coordinator at University of California San Diego Moores Cancer Center at the time of this study, and currently a medical student at Emory University School of Medicine, said in a press release. “We also observed an increase in the proportion of Hispanic women who consented to be part of a national clinical trial, including a substantial increase in Spanish-speaking patients.”

Chloe Lalonde

University of California San Diego Moores Cancer Center is located in a predominately well-off, non-Hispanic white region of San Diego County. Because the cancer center has not routinely accepted uninsured individuals, clinicians in this area have been challenged to care for underserved, low-income individuals and recruit them for clinical trials. Although San Diego County is composed of approximately 35% Hispanic individuals, only 17% of patients on trials are Hispanic.

To determine whether the ACA has increased patient access to the cancer center and clinical trials, Lalonde and colleagues evaluated the proportion of Hispanic women who received care between 2010 and 2013 — or before the ACA’s implementation — compared with between 2014 and 2015, or after the ACA was implemented.

From January 2010 to January 2014, Hispanic women represented 10.1% of breast cancer diagnoses at the cancer center. Researchers observed that this rate remained stable each year.

However, following January 2014, the proportion of breast cancer diagnoses that occurred in Hispanic women increased to 13.7% (P = .002). Hispanic women represented 11.5% of diagnoses in 2015 and 16% in 2016, suggesting an increase overtime.

Researchers then evaluated data from 236 women who signed screening consent for the I-SPY 2 trial during the same time periods.

The proportion of Hispanic women in the trial increased from 11.7% before the ACA to 22.2% after the ACA (P = .03). Researchers also observed a nearly sixfold increase in the proportion of trial consents among Spanish-speaking Hispanic women (2.3% vs. 13.9%; P = .0009).

“California enrolled 3.3 million people during the first 6 months of open enrollment,” Lalonde said. “Initially, enrollment among Hispanics was slow due to limited resources tailored to language and culture, but as resources increased via community-level outreach, enrollment increased.”

The single-institution nature of this study may be a limitation to the findings, according to the researchers.

“From both scientific and ethical standpoints, it is critical to have diverse patient populations represented in clinical trials; therefore, it is important to examine the effects of health care policies and practices to identify both barriers and facilitators that patients encounter in seeking and/or being offered participation in clinical trials,” Lalonde said. – by Alexandra Todak

Reference:

Lalonde C, et al. Abstract PR07, C15. Presented at: AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Sept. 25-28, 2016; Fort Lauderdale, Fla.

Disclosure: Moores Cancer Center funding this study. Lalonde reports no relevant financial disclosures.