Affordable Care Act increased cancer trial participation among Medicaid-insured patients
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Key takeaways:
- Medicaid expansion led to an annual increase in cancer clinical trial participation.
- The association appeared highest in states that adopted Medicaid expansion between 2014 and 2015.
Expansion of the Affordable Care Act significantly increased cancer clinical trial participation among patients with Medicaid insurance, according to study results published in JAMA Oncology.
The greatest increases in clinical trial participation occurred in states that expanded access to Medicaid, researchers noted.
Rationale and methodology
“The Medicaid expansion of the Affordable Care Act enabled many low-income individuals to become eligible for Medicaid,” Joseph M. Unger, PhD, MS, SWOG Cancer Research Network health services researcher and biostatistician at Fred Hutchinson Cancer Research Center, told Healio. “Our prior research has shown that lower income patients with cancer are much less likely than higher income patients to participate in cancer clinical trials. This motivated us to examine whether broader access to Medicaid in general also improved access to cancer clinical trials.”
Unger and colleagues sought to examine whether the implementation of the 2014 Affordable Care Act’s Medicaid expansion had an association with increased participation among 51,751 patients (mean age, 50.6 years; 67.3% women) included in the SWOG Cancer Research Network. The analysis included individuals with private insurance or Medicaid (9.1%) who enrolled in trials between April 1, 1992, and Feb. 29, 2020.
Researchers used interrupted time-series analysis with segmented logistic regression and adjusted the monthly unemployment rate and presidential administration to reflect potential differences in Medicaid use associated with economic conditions and national administrative policies.
Findings
Results showed the Medicaid expansion led to a 19% annual increase (OR = 1.19; 95% CI, 1.11-1.28) in cancer clinical trial participation among patients with Medicaid insurance, which led to a 52% increase (OR = 1.52; 95% CI, 1.29-1.78) in trial participation over time compared with what investigators expected among the Medicare enrollee population.
In addition, the association appeared highest in states that adopted Medicaid expansion between 2014 and 2015 (OR = 1.26; 95% CI, 1.15-1.38) compared with other states that did not adopt the expansion during that time frame (OR = 1.08; 95% CI, 0.96-1.21).
Researchers found that 17.8% of patients (95% CI, 15-20.8) had Medicaid-based insurance by February 2020 vs. an anticipated 6.9% of patients had the expansion not occurred (95% CI, 4.4-10.3).
Researchers acknowledged that the study is based on data from NCI-funded clinical trials and does not include data from trials sponsored by pharmaceutical companies.
Thus, additional research is needed to assess whether the findings extend to cancer clinical trials that are not publicly funded, they wrote in their analysis.
Implications
The findings showed how “seemingly intractable issues of poor access to clinical trials for vulnerable populations are amenable to change and improvement by targeted policies,” Unger told Healio.
“Congress recently implemented the Cancer Treatment Act, which mandates that state-level Medicaid programs cover the routine care costs of clinical trials for patients with Medicaid,” he said. “Going forward, research is required to examine the impact of this new law on further improving access to cancer clinical trials for patients with Medicaid.”
The impact of Medicaid expansion on clinical trial participation is unclear at the moment, especially given that participation tends to be low among well-resourced individuals, according to Samilia Obeng-Gyasi, MD, MPH, researcher in the division of surgical oncology at The Ohio State University Comprehensive Cancer Center, and Oluwadamilola M. Fayanju, MD, MA, MPHS, researcher in the division of breast surgery at Perelman School of Medicine at University of Pennsylvania.
“Specifically, the effect of Medicaid expansion on socially and economically marginalized groups (eg, those insured by or eligible for Medicaid) in the clinical trial setting is virtually unexplored,” they wrote in an accompanying editorial. “The cohort study by Unger [and colleagues] provides needed insight into outcomes after Medicaid expansion in the clinical trial setting.”
References:
- Obeng-Gyasi S, et al. JAMA Oncol. 2023;doi:10.1001/jamaoncol.2023.2699.
- Policy to expand Medicaid coverage linked to higher participation in cancer clinical trials among people insured by Medicaid (press release). Available at: Policy to expand Medicaid coverage linked to higher participation in cancer clinical trials among people insured by Medicaid | Fred Hutchinson Cancer Center. Published Aug. 17, 2023. Accessed Oct. 3, 2023.
- Unger JM, et al. JAMA Oncol. 2023;doi:10.1001/jamaoncol.2023.2800.
For more information:
Joseph M. Unger, PhD, MS, can be reached at junger@fredhutch.org.
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