Medicaid Expansion Is Associated With Decreased Mortality in Patients Diagnosed With Colorectal Cancer and Synchronous Liver Metastasis.

Abstract

To evaluate the impact of Medicaid expansion (ME) and its timing on treatment patterns and survival in patients younger than 65 years with colorectal cancer and synchronous liver metastasis (CRLM). Management of CRLM requires multidisciplinary oncologic and surgical care. In 2010, the Affordable Care Act expanded Medicaid eligibility to adults earning ≤138% of the Federal Poverty Level. The effect of ME on outcomes in metastatic colorectal cancer requiring complex care remains incompletely defined. The SEER 2022 database was queried for patients <65 years old diagnosed with CRLM from 2010 to 2019. Patients with extrahepatic metastases or no follow-up were excluded. Event-study difference-in-differences analyses compared outcomes between expansion and nonexpansion states. Cox proportional hazards models clustered by state adjusted for demographic and socioeconomic factors evaluated 3-year all-cause and disease-specific mortality. Among 33,216 patients with CRLM, 13.4% underwent metastasectomy. In ME states, the 3-year disease-specific mortality rate decreased from 75% pre-expansion to 68% after 6+ years. Risk of 3-year disease-specific mortality in ME states compared with nonexpansion states was reduced beginning 2-3 years after expansion and persisted over time (HR range 0.90-0.95). Reduction in risk of disease-specific mortality was most pronounced among patients undergoing liver metastasectomy (HR range: 0.71-0.85). ME was not associated with increased likelihood of metastasectomy. ME was independently associated with improved survival among patients with CRLM, particularly those receiving surgical and systemic therapy. These data suggest ME may improve continuity of complex multidisciplinary oncologic care and access to systemic therapy.