Nogueira L, Chawla N, Han X, Jemal A, Yabroff KR. Colorectal Cancer Care among Young Adult Patients after the Dependent Coverage Expansion under the Affordable Care Act. Journal of the National Cancer Institute. 2019 Dec 19.
Abstract: The impact of the Dependent Coverage Expansion (DCE) under the Affordable Care Act (ACA) on receipt of colorectal cancer treatment has yet to be determined. We identified newly diagnosed DCE-eligible (aged 19-25 years, n = 1,924) and DCE-ineligible (aged 27-34 years, n = 8,313) colorectal cancer patients from the National Cancer Database during 2007-2013. All statistical tests were two-sided. Post-ACA, there was a statistically significant increase in early stage diagnosis among DCE-eligible (15 percentage points increase, p<.001), but not DCE-ineligible (p = .09) patients. DCE-eligible patients resected for IIB-IIIC colorectal cancer were more likely to receive timely adjuvant chemotherapy (HR = 1.34, CI = 1.05, 1.71; 7.0 days decrease in restricted mean time from surgery to chemotherapy, p=.01), with no differences in DCE-ineligible patients (HR = 1.10, CI = 0.98, 1.24; 2.1 days decrease, p=.41) post-ACA. Our findings highlight the role of the ACA in improving access to potentially life-saving cancer care, including a shift to early-stage diagnosis and more timely receipt of adjuvant chemotherapy.