Journal of the American Academy of Dermatology · 2025
Medicaid expansion is associated with improved survival in patients with resected Merkel cell carcinoma: A National Cancer Database analysis.
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Li Yingjoy, Yuen Sarah W, Tran Tu, Lee Bonnie A, Doan Linda T, Linden Kenneth G, Jakowatz James G, Eng Oliver, Yamamoto Maki, Tran Thuy B
Аннотация
BACKGROUND: Medicaid expansion (ME) under the Affordable Care Act sought to improve health care access for low-income individuals, but its impact on Merkel cell carcinoma (MCC) remains unknown.
OBJECTIVE: To evaluate whether ME is associated with improved survival among patients with resected MCC.
METHODS: The National Cancer Database (2010-2020) was queried for patients with stage I to III resected MCC. Patients were stratified by state expansion status. Overall survival (OS) was estimated using the Kaplan-Meier method. Multivariable Cox regression identified predictors of OS.
RESULTS: Among 14,802 patients, 9014 (60.9%) resided in expansion states. Patients in expansion states presented with more frequent adverse features, including larger tumors (>2 cm: 42.7% vs 38.4%, P = .003), nodal disease (29.3% vs 27.4%, P = .018), and lymphovascular invasion (37.8% vs 33.6%, P < .001). Five-year OS was higher for patients in expansion states with both stage I to II (61.4% vs 58.3%, P = .022) and stage III disease (46.9% vs 44.4%, P = .044). On multivariable analysis, residence in an expansion state (hazard ratio: 0.92, P = .02) and diagnosis during the post-ME era (hazard ratio: 0.87, P < .001) predicted improved survival.
LIMITATIONS: Retrospective design and lack of recurrence or treatment timing data.
CONCLUSIONS: ME was associated with improved stage-for-stage survival for resected MCC, highlighting the importance of expanded insurance coverage in facilitating timely cancer care.
OBJECTIVE: To evaluate whether ME is associated with improved survival among patients with resected MCC.
METHODS: The National Cancer Database (2010-2020) was queried for patients with stage I to III resected MCC. Patients were stratified by state expansion status. Overall survival (OS) was estimated using the Kaplan-Meier method. Multivariable Cox regression identified predictors of OS.
RESULTS: Among 14,802 patients, 9014 (60.9%) resided in expansion states. Patients in expansion states presented with more frequent adverse features, including larger tumors (>2 cm: 42.7% vs 38.4%, P = .003), nodal disease (29.3% vs 27.4%, P = .018), and lymphovascular invasion (37.8% vs 33.6%, P < .001). Five-year OS was higher for patients in expansion states with both stage I to II (61.4% vs 58.3%, P = .022) and stage III disease (46.9% vs 44.4%, P = .044). On multivariable analysis, residence in an expansion state (hazard ratio: 0.92, P = .02) and diagnosis during the post-ME era (hazard ratio: 0.87, P < .001) predicted improved survival.
LIMITATIONS: Retrospective design and lack of recurrence or treatment timing data.
CONCLUSIONS: ME was associated with improved stage-for-stage survival for resected MCC, highlighting the importance of expanded insurance coverage in facilitating timely cancer care.