Specialized cancer care for medullary thyroid cancer: A Surveillance, Epidemiology, and End Results-Medicare study of Traditional Fee-For-Service and Medicare Advantage beneficiaries.

BACKGROUND

Medullary thyroid cancer is rare and requires specialized knowledge. Medicare Advantage is associated with reduced access to top-rated cancer hospitals and worse outcomes for complex cancer surgery than Traditional Fee-for-Service Medicare. Whether this applies to medullary thyroid cancer is unknown. We described access to accredited cancer centers and compared outcomes between Traditional Fee-for-Service Medicare and Medicare Advantage beneficiaries with medullary thyroid cancer.

METHODS

This retrospective cohort study of Medicare beneficiaries who underwent surgery for a new diagnosis of medullary thyroid cancer in the Surveillance, Epidemiology, and End Results-Medicare database (2018-2021) examined the association between Medicare type (Traditional Fee-for-Service Medicare or Medicare Advantage) and utilization of a Commission on Cancer-accredited center, with stratification by state. Logistic regression models evaluated risk-adjusted Commission on Cancer hospital utilization.

RESULTS

We identified 381 patients, of whom 231 (60.6%) were enrolled in Traditional Fee-for-Service Medicare and 150 (39.4%) in Medicare Advantage. In the overall analysis, there were no significant differences in accredited cancer center utilization by Medicare type (Traditional Fee-for-Service Medicare: 83.6% versus Medicare Advantage: 78.0%; P = .22). When stratified by state, Medicare Advantage beneficiaries were less often treated at accredited cancer centers in California and New York. Postoperative complications, delayed reoperation, and disease-specific survival did not differ significantly by Medicare type.

CONCLUSION

Medicare type is associated with state-level variation in the utilization of accredited cancer centers for medullary thyroid cancer surgical care. Patients with medullary thyroid cancer should consider access issues in their local context when selecting Medicare plan types. Outcome studies of health care utilization by Medicare plan type must consider the geographic setting as a component of their analysis to responsibly report results.