Document Type
Article
Publication Date
6-23-2025
Abstract
Purpose: Despite growing research on Medicaid expansion’s impact on cancer outcomes, there remains a critical need for a more nuanced understanding of how expansion affects cancer care and survival. This study assesses whether Medicaid expansion was associated with improved receipt of standard treatment, timely treatment initiation, and overall survival among colon cancer patients, while examining the specific factors influencing these outcomes. Methods: Using Ohio’s state cancer registry linked with Medicaid records, we analyzed 688 Medicaid-enrolled patients with non-metastatic colon cancer diagnosed between May 2011 and December 2017. We employed multivariable Poisson and Cox proportional hazard regression analyses to evaluate the impact of Medicaid expansion on treatment and survival outcomes, controlling for individual- and area-level factors. Results: We observed no significant changes in the likelihood of receipt of standard treatment or timely treatment initiation post-expansion vs. pre-expansion, and no significant differences in these outcomes by Medicaid eligibility criteria post-expansion. However, we observed significantly improved survival (hazard ratio, HR 0.49 [0.28, 0.88]) among patients who became newly eligible for Medicaid under the ACA vs. pre-expansion. Patients enrolled emergently (shortly after/upon diagnosis) were more likely to receive standard treatment (risk ratio, RR 1.14 [1.02, 1.27]). Conclusions: Our findings provide nuanced insights into Medicaid expansion’s impact on colon cancer care, showing that while expansion did not affect treatment measures, it improved survival among newly eligible patients. Higher standard treatment likelihood among emergently enrolled patients suggests complex post-expansion care dynamics. Further research should investigate mechanisms underlying improved survival and develop interventions to enhance treatment quality alongside observed survival benefits.
Keywords
cancer treatment patterns, colon cancer, medicaid claims data, medicaid expansion, state registry, survival
Language
English
Publication Title
Cancer Causes and Control
Grant
132678-RSGI-19-213-01-CPHPS
Rights
© The Author(s) 2025. This is an Open Access work distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Recommended Citation
Eom, K.Y., Dong, W., Hoehn, R.S. et al. Association of Medicaid expansion with colon cancer care: treatment patterns and survival in non-metastatic cases from state registry-claims data. Cancer Causes Control 36, 1263–1274 (2025). https://doi.org/10.1007/s10552-025-01983-8
Manuscript Version
Final Publisher Version