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Women with ovarian cancer before the age of Medicare were more likely to be diagnosed at an early stage and to receive treatment within 30 days of diagnosis after the diagnosis. Adoption of the Affordable Care Act (ACA) that previously, according to the findings of the study presented to the 2019 of the American Society of Society Annual Congress of Clinical Oncology .
The results showed a relative gain of 1.7% in ovarian cancer diagnosed at the early stage (defined at stages I or II) in women aged 21 to 64, compared with women aged 65 or over. years and older, many of whom were presumed to benefit from Medicare. The 1.7% increase indicates that of the 22,000 women diagnosed each year, about 400 more could be diagnosed at an early and curable stage, thus extending the potential survival time, said lead author Anna Jo Smith, MD, MPH ,.
The study also showed a 1.6% increase in women aged 21 to 64 treated within 30 days of diagnosis compared to the control group.
Among women aged 21 to 64 with public insurance, there were relative gains of 2.5% in terms of ovarian cancer diagnosis and treatment delay in women from 21 to 64 years old.
Smith, resident of Johns Hopkins Department of Gynecology and Obstetrics in Baltimore, Maryland, and Amanda Nickles Fader, MD, director of Kelly's Oncology Gynecology Department and badociate professor of John Hopkins, evaluated the data on the ovarian cancer from the national cancer database. , which records data on about 70% of all new cases of ovarian cancer. They concluded that ACA resulted in an increase in ovarian cancer treatment and that more treatments were given within 30 days of diagnosis, thus increasing the chances of survival for women with cancer. # 39; ovary.
"Detecting and treating ovarian cancer at an early stage saves lives and reduces health care costs compared to treating cancer at a more advanced and incurable stage," Smith said. "Having health insurance plays a major role in whether or not a woman has access to care providers who can monitor the symptoms and act on those symptoms if necessary."
The authors of the study were able to measure the improvement of ovarian cancer and its treatment using a differences difference approach, which allows for badysis with the help of a comparison control group not affected by the evaluated changes. In this case, the investigators compared the younger women with those aged 65 or older, who would likely be on Medicare and not influenced by the ACA move.
In the United States, 22,000 women are diagnosed each year with ovarian cancer. More than 75% of people with early-stage ovarian cancer live 5 years or more; this percentage falls to less than 30% for those diagnosed at an advanced stage. Since there is no screening test to detect ovarian cancer at an early stage, cancer can often be present but not be detected for years, in part because of the tendency of cancer to present with cancer. subtle symptoms. The coverage offered by ACA to an increased number of Americans has allowed women with cancer not only to see their doctor, but also to report the symptoms to their doctor, to pbad laboratory tests to confirm the presence of cancer and then receive treatment. The expanded coverage accessed by the ACA has made early detection of cancer more and more possible.
In 2017, nearly 12.7 million people had received health coverage as a result of the implementation of the ACA in 2010. At the same time, the proportion of uninsured Americans has gone from 16% in 2010 to less than 12% in 2016.
Investigators used data on the stage of diagnosis of ovarian cancer and the delay in treatment in women aged 21 to 64 years and 65 years and over diagnosed from 2004 to 2009 (before ACA; 35,842 patients) and from 2011 to 2014 (after ACA, 37,145 patients).
Investigators looked at the type of insurance available to women and adjusted the results by race, rural demographics, neighborhood household income, level of education, distance traveled for care, Census Region and Practice Framework for Care. They also adjusted on the basis of Charlson 's comorbidity score, which predicts the risk of death in the year following hospitalization of people with concomitant illnesses.
The study was funded by a grant from the Kelly Society of Johns Hopkins Department of Gynecology and Obstetrics. The researchers will broaden their scope to include the years after 2014 to evaluate the impact of ACA on the early diagnosis and treatment of women with gynecological cancer. .
Smith AJ, Nickles Fader A. Impact of the Affordable Care Act on early diagnosis and treatment of ovarian cancer in women. J Clin Oncol. 2019; 37 (suppl., Abstract LBA5563).
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