Access to Quality Cancer Care Improves Survival Under the ACA

Inadequate access to health care can truly be a life or death matter, so health care policy designed to improve access to care, as the Affordable Care Act (ACA) is, can have a fundamental effect on making progress against cancer-related mortality and improving the quality of the care delivered, noted Fumiko Chino, MD, assistant attending radiation oncologist at Memorial Sloan Kettering Cancer Center in New York.

TranscriptHow does the work you are presenting at ASCO on changes in cancer mortality rates after adoption of the Affordable Care Act reflect this year’s theme “Unite and Conquer: Accelerating Progress Together”?

Our study was really the first to show a directly measured cancer survival benefit from Medicaid expansion under the ACA on a national scale. You know, there are many ways to improve health care status in our country, whether it be from new discoveries in medicine or cutting-edge technologies. However, these benefits can't really affect real change if there's still inadequate access to health care itself. And so health care policy designed to improve access can really, you know, level the playing field, and our study shows the impact policy can have on making progress in cancer-specific mortality. And we really do believe that improving access to health care, by doing this, the Affordable Care Act did truly allow the United States to accelerate progress in quality cancer care delivery.

You state in connection with your study that cancer is a health care—amenable condition, meaning access to health care is expected to improve survival outcomes. Conversely, should we expect lack of access to have an adverse effect on outcomes?

Yes, I think sadly, there's now a wealth of evidence that shows that poor access to health care can really negatively affect cancer outcomes. And we know that patients with poor access are more likely to present at advanced stages; they're less likely to receive curative treatments, like surgery or radiation; and they may actually have less supportive care during their cancer treatment and suffer from more side effects. So our current work really highlights the importance of health care access even further. It shows that inadequate access to health care can truly be a life or death matter.

Are there any certain cancers where this would be more apparent?

I do feel that that's certainly true. And we know that some cancers are much more aggressive and there's much less time to actually start a definitive treatment for them. And so the next steps for our study is actually to analyze it, sort of cancer by cancer, to see which cancers did have the most benefit from expansion under the Affordable Care Act. Our hypotheses are that cancers like, for example, cervical cancer—a rapidly developing cancer that has been seen in patients who have historically poor access to health care—that this may be one of the cancers, for example, that has the highest benefit. But we're still doing this type of analysis.