Medicaid Expansion May Explain Increased Palliative Care Use in Advanced Cancers

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Patients with advanced cancers who live in states that expanded Medicaid were more likely to receive early palliative care, although utilization remains low in the U.S.

More patients with advanced cancers — including pancreatic, colorectal, lung, head and neck and non-Hodgkin lymphoma — received palliative care services, which may be a result of Medicaid expansion under the Affordable Care Act, recent study findings demonstrated.

“Our findings are encouraging, especially with growing evidence of the important benefits of palliative care for patients with cancer,” Dr. Xuesong Han, lead author of the study and scientific director of health services research at the American Cancer Society, said in a release from the organization. “It’s imperative to know how to target ways to increase access to these services, as use, overall, still remains low in the U.S.”

According to the National Cancer Institute, palliative care aims to improve the quality of life and reduce pain in patients with cancer. This can include therapies to shrink, remove or slow the growth of a tumor that may be causing pain, in addition to caregiver and family support.

“The goal of palliative care is to prevent or treat, as early as possible, the symptoms of the disease and the side effects caused by treatment of the disease. It also attends to the psychological, social and spiritual problems caused by the disease or its treatment,” according to the National Cancer Institute’s website.

Researchers noted in the study, which was published in the journal Health Affairs, that although clinical guidelines have endorsed the use of early palliative care in patients with advanced cancer, its utilization has been low in the United States. The study focused on assessing the potential link between Medicaid expansion under the Affordable Care Act and palliative care utilization in patients who were newly diagnosed with advanced-stage cancers.

Graphs depicting the following: Increases in Palliative Care Utilization Before and After Medicaid Expansion, 17% to 18.9% in Expansion States, 15.7% to 16.7% in Non-Expansion States

There was a slightly higher increase in palliative care use in states with Medicaid expansion, recent research showed.

The rate at which patients received early palliative care — or part of their first-course treatment — increased from 17% to 18.9% in states that expanded Medicaid. This also increased from 15.7% to 16.7% in states that did not expand the program.

“These study results suggest that the expansion of Medicaid coverage may increase palliative care use,” Han said. “They also point to a potentially widening geographic disparity in receipt of guideline-recommended palliative care between states with different health policies regarding income-based Medicaid eligibility requirements.”

The increase in palliative care utilization in Medicaid-expanded states was greatest in patients with advanced colorectal, pancreatic, oral cavity and pharynx, and lung cancers, in addition to non-Hodgkin lymphoma.

“Research continues to underscore the impact increasing access to comprehensive, affordable health insurance through Medicaid has on cancer patient survival and the further importance of providing greater access to palliative care services to those positive outcomes,” Lisa Lacasse, president of the American Cancer Society Cancer Action Network, said in the release.

The American Cancer Society Cancer Action Network has been an advocate for legislation focused on palliative care access, according to the release, and continues to do so for patients at any age or stage of their diagnosis.

“To fully improve patient quality of life, Congress should prioritize legislation that educates patients and providers about the availability and benefits of palliative care and expand federal palliative care research,” Lacasse said. “It’s also crucial all remaining states expand access to Medicaid, as access to comprehensive health care is key to closing the gap on the health inequities we see in these underserved areas and ensure everyone has a fighting chance against cancer.”

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