Implementation of the Patient Protection and Affordable Care Act (ACA) in 2010 coincided with reductions in advanced renal cell carcinoma (RCC) at diagnosis, according to new data presented at SUO 2020, the virtual annual meeting of the Society of Urologic Oncology.

Using the National Cancer Database, investigators identified 83,310 patients (aged 40 to 64 years) eligible for Medicaid and with newly diagnosed RCC in the United States from 2010 to 2016. Following ACA implementation, the percentage of insured patients in both Medicaid-expansion and non-expansion states increased by 4.0% and 2.1%, respectively, Juan Javier-DesLoges, MD, as SUO fellow at UC San Diego Health in La Jolla, California, reported. The largest significant increases in insurance coverage occurred in expansion states, with increased Medicaid uptake by patients of low-income (absolute percentage change [APC] +11.0%), middle-income (APC +4.20%), and high-income (APC +4.00%). Concurrently, the uninsured rate declined by a significant 1.14% more among expansion than non-expansion states, he noted.

In Medicaid-expansion states, the proportion of patients diagnosed with stage 1 or 2 RCC after ACA implementation increased by 4.6% among low-income patients and 1.6% among middle-income patients, with corresponding decreases in the proportion of patients diagnosed with stage 3 or 4 RCC, Dr Javier-DesLoges reported.

By comparison, in non-expansion states, the proportion of patients diagnosed with stage 1 or 2 RCC did not change significantly among low-income patients after ACA went into effect, but rose by 1.40% among middle-income patients, with a corresponding decrease in the diagnosis of stage 3 or 4 RCC.


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The association between low income and premature death also decreased after ACA implementation, according to both intent-to-treat and adjusted Cox Regression analyses.

“Our findings suggest that ACA implementation had an immediate and sustained impact on downward stage migration in low/middle-income patients and attenuation of income status as a risk [factor] for mortality in these patients with RCC,” Dr Javier-DesLoges stated.

Reference

Javier-DesLoges J, Yuan J, Soliman S, et al. The association between the Affordable Care Act on insurance status, cancer stage, and overall survival in patients with renal cancer. Presented at: SUO 2020, December 3-5, 2020. Poster 32.