ACA May Impact Ovarian Cancer Outcomes

CHICAGO-Under the Affordable Care Act (ACA), women with ovarian cancer were more likely to be diagnosed at an early stage and receive treatment within 30 days of diagnosis, according to researchers at Johns Hopkins School of Medicine, who presented the results (abstract LBA5563) at the 2019 American Society of Clinical Oncology (ASCO) Annual Meeting, held May 31–June 4 in Chicago. They conducted an analysis of data from the National Cancer Database and found that after implementation of the 2010 ACA, ovarian cancer was diagnosed and treated at an earlier stage among women under age 65. More women also received treatment within 30 days of diagnosis, subsequently increasing their chances of survival.

Lead study author Anna Jo Smith, MD, MPH, a resident in the Johns Hopkins department of gynecology and obstetrics in Baltimore, said detecting and treating ovarian cancer at an early stage saves lives and lowers healthcare costs compared with treatment of cancer at a more advanced, incurable stage. She said having health insurance plays a major role in whether a woman has access to providers who can monitor symptoms. Currently, there is no acceptable screening test that can detect ovarian cancer at an early stage, and subtle symptoms can be present for years. Smith said the sooner a woman reports these symptoms to her doctor, the sooner treatment can begin.

Coverage became available after the ACA was signed into law in March 2010, and by 2016 to 2017, nearly 12.7 million people were insured through the ACA. The proportion of Americans who were uninsured dropped from 16% in early 2010 to less than 12% by 2016. The researchers examined ovarian cancer data from approximately 70% of all new ovarian cancer cases. They looked at women diagnosed and treated from 2004 to 2009 (pre-ACA; 35,842 patients) and 2011 to 2014 (post-ACA; 37,145 patients). The team looked at disease stage at time of diagnosis and time to treatment for women ages 21 to 64 years and compared them to women age 65 and older (control group).

The investigators assessed the type of insurance that women had and adjusted for race, rural demographics, and neighborhood household income. They also adjusted for education level, distance traveled for care, Census region, and practice setting where they received care. The researchers found that compared with women 65 and older, there was a relative gain of 1.7% in early-stage diagnosis (defined as stage I or II) of ovarian cancer. There was also a relative improvement of 1.6% in the women treated within 30 days of diagnosis for those ages 21 to 64 compared to women 65 and older. The study showed women who received public insurance post-ACA achieved the greatest benefits.

Among publicly insured women, there were relative gains of 2.5% in early-stage diagnosis and timely treatment in those ages 21 to 64 compared with women age 65 and older. The findings showed that all the improvements were seen regardless of race, income, or education level.

Smith said a 1.7% difference in being diagnosed earlier may not sound very large, but when considering there are 22,000 women diagnosed with ovarian cancer in the United States annually, it means that close to 400 more women could be diagnosed at an early, treatable stage and have a good chance of living a longer life. “As stage and treatment are major determinants of survival of ovarian cancer, these gains under the Affordable Healthcare Act may have long-term impacts on the survival, health, and well-being of women with ovarian cancer,” she said.

ASCO Expert Merry-Jennifer Markham, MD, of the University of Florida in Gainesville, who was part of the panel for the news conference at ASCO, said early detection and prompt treatment matters in all types of cancer, but especially in ovarian cancer. She said this study confirms that access to health insurance also matters because it can help overcome disparities in access to care and extend survival. “Access to healthcare ultimately may actually improve long-term outcomes by increasing access to earlier diagnosis and access to earlier treatment. It is crucial for these women with ovarian cancer,” she said.