Association of the Affordable Care Act With Ovarian Cancer Care.

Abstract

To estimate how implementation of the 2010 Affordable Care Act (ACA) might be associated with stage at diagnosis and time to treatment for women with ovarian cancer. We conducted a retrospective cohort study using difference-in-differences analysis comparing stage at diagnosis and time to treatment before and after implementation of the ACA among women with ovarian cancer aged 21-64 years (exposure group) compared with women aged 65 years or older (control group). Using 2004-2015 data from the National Cancer Database, outcomes were analyzed overall and by insurance type and race, adjusting for urban-rural, income and education level, comorbidities, distance traveled for care, region, and care at an academic center. A total of 39,999 ovarian cancer cases prereform and 36,564 postreform were identified for women aged 21-64 years compared with 31,290 cases prereform and 29,807 postreform for women aged 65 years or older. The ACA was associated with increased early-stage diagnosis detection for women aged 21-64 years compared with women 65 and older (difference-in-differences 1.4%, 95% CI 0.4-2.4). The ACA was associated with more women receiving treatment within 30 days of ovarian cancer diagnosis (2.3%, 95% CI 1.7-3.0). Among women with public insurance, the ACA was associated with a significant improvement in early-stage diagnosis and receipt of treatment within 30 days of diagnosis (difference-in-differences 2.7%, 95% CI 1.0-4.5, difference-in-differences 2.5%, 95% CI 1.2-3.8). Improvements in time to treatment were seen across race and income groups. Implementation of the ACA was associated with earlier ovarian cancer stage at detection and treatment within 30 days of diagnosis.