Medicaid Expansion Associated with Improved Survival of Head and Neck Cancer

Clinical Question

How does stage at presentation and survival compare when looking at cases of head and neck squamous cell carcinoma in Medicaid-expanded states versus non-expanded states?

Bottom Line

Medicaid expansion is associated with fewer stage IV cases and with improved survival in cases of head and neck squamous cell carcinoma.

BACKGROUND: Studies demonstrate the associations of insurance type and status on head and neck cancer treatment access and outcomes; however, no study has assessed the impact of Medicaid expansion, which widens eligibility to include adults under 65 years of age with incomes up to 138% of the federal poverty level, on head and neck cancer survival outcomes.

STUDY DESIGN: Retrospective cohort study

SETTING: Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago

SYNOPSIS: Researchers mined the head and neck with human papillomavirus status database within the Surveillance, Epidemiology, and End Results (SEER) Program to isolate a de-identified data set of head and neck squamous cell carcinoma cases diagnosed from 2010 to 2016. Data was extracted on patient age, sex, and race. The team included only patients who have Medicaid or no insurance. Expanded (EXP) states were those accepting and implementing Medicaid expansion in 2016 or earlier; nonexpanded (NEXP) states implemented expansion after 2016 or not at all. The case selection process resulted in 2,215 patients (1,778 males; 2,152 “older adults,” or those between ages 40 and 64) meeting inclusion criteria. Compared to NEXP states, EXP states had a significantly larger proportion of Medicaid patients (20.3% versus 16.7%). Multivariable analysis showed that cases under Medicaid expansion were 31% less likely to present with stage IV disease compared to cases in NEXP states. Multivariable Cox proportional hazards models showed that cases under Medicare expansion were 32% less likely to die compared to cases in NEXP states. Authors note that the study does not compare pre-expansion cases with post-expansion cases. Study limitations include its retrospective nature.

CITATION: Arch RS, Fei-Zhang DJ, Patel U, et al. Influence of Medicaid expansion on head and neck squamous cell carcinoma presentation and survival. Otolaryngol Head Neck Surg. 2024;170:431-437.

DISCUSSION: “This thoughtful retrospective cohort study by Arch and colleagues analyzed SEER data for head and neck cancer patients in states with expanded Medicaid versus states with nonexpanded Medicaid. The authors found that patients in Medicaid expansion states were 31% less likely to present with stage IV disease and had 32% lower mortality risk compared to patients in nonexpanded Medicaid states. Improved healthcare access in general and Medicaid expansion in particular remain important factors to address healthcare disparities for vulnerable head and neck cancer patients.” Dr. Nathan Grohmann