Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jan;30(1):179-188.
doi: 10.1245/s10434-022-12563-4. Epub 2022 Sep 28.

Palliative Therapies in Metastatic Pancreatic Cancer: Does Medicaid Expansion Make a Difference?

Hamza Khan  1 , Deepa Cherla  2 , Krista Mehari  3 , Manish Tripathi  4 , Thomas W Butler  5 , Errol D Crook  5 , Martin J Heslin  2 , Fabian M Johnston  1 , Annabelle L Fonseca  6
Affiliations

Palliative Therapies in Metastatic Pancreatic Cancer: Does Medicaid Expansion Make a Difference?

Hamza Khan et al. Ann Surg Oncol. 2023 Jan.

Abstract

Background: The aim of this study was to evaluate the impact of medicaid expansion (ME) on receipt of palliative therapies in metastatic pancreatic cancer patients.

Patients and methods: A difference-in-differences (DID) approach was used to analyze patients with metastatic pancreatic cancer identified from the National Cancer Database diagnosed during two time periods: pre-expansion (2010-2012) and post-expansion (2014-2016). Patients diagnosed while residing in ME states were compared with those in non-ME states. Multivariable logistic regression was used to identify predictors of receipt of palliative therapies.

Results: Of 87,738 patients overall, 7483(18.1%) received palliative therapies in the pre-expansion, while 10,211(21.5%) received palliative therapies in the post-expansion period. In the pre-expansion period, treatment at a high-volume facility (HVF) (odds ratio [OR] 1.10, 95% confidence interval [CI] 1.02-1.18) and non-west geographic location were predictive of increased palliative therapies. In the post-expansion period, treatment at an HVF (OR 1.09, 95% CI 1.02-1.16), geographic location, and living in an ME state at the time of diagnosis (OR 1.14, 95% CI 1.06-1.22) were predictive of increased palliative therapies. Older age, highest quartile median income (zip-code based), and treatment at a nonacademic facility were independently associated with decreased palliative therapies in both periods. DID analysis demonstrated that patients with metastatic pancreatic cancer living in ME states had increased receipt of palliative therapies relative to those in non-ME states (DID = 2.68, p < 0.001).

Conclusions: The overall utilization of palliative therapies in metastatic pancreatic cancer is low. Multiple sociodemographic disparities exist in the receipt of palliative therapies. ME is associated with increased receipt of palliative therapies in patients with metastatic pancreatic cancer.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: All authors declare no conflicts of interest

Figures

Figure 1.
Figure 1.
Difference in Difference analysis showing receipt of palliative in the pre-expansion (2010-2012) and post-expansion (2014-2016) periods in Medicaid expansion and non-Medicaid Expansion states
See this image and copyright information in PMC

Comment in

References

    1. Centers for Disease Control and Prevention. An update on cancer deaths in the united states. https://www.cdc.gov/cancer/dcpc/research/update-on-cancer-deaths/index.htm. Updated 2021. Accessed 8/29/, 2021.
    1. National Cancer Institute. SEER cancer stat facts: Pancreatic cancer. Bethesda, MD: Web site. https://seer.cancer.gov/statfacts/html/pancreas.html. Accessed August 4th, 2021.
    1. Kulaylat AS, Mirkin KA, Hollenbeak CS, Wong J. Utilization and trends in palliative therapy for stage IV pancreatic adenocarcinoma patients: A US population-based study. Journal of gastrointestinal oncology. 2017;8(4):710. - PMC - PubMed
    1. Ju MR, Paul S, Polanco P, et al. Underutilization of palliative care in metastatic foregut cancer patients is associated with socioeconomic disparities. Journal of Gastrointestinal Surgery. 2020:1–8. - PubMed
    1. Conrad C, Lillemoe KD. Surgical palliation of pancreatic cancer. The Cancer Journal. 2012;18(6):577–583. - PubMed

LinkOut - more resources