Medicaid Coverage Has No Discernible Impact on Survival in Small-Cell Lung Cancer

Medicaid has proven benefits for the poorest in America, particularly when it comes to primary care or long-term management of a disease like diabetes, where better access means better outcomes.

But what about an emergent, rapidly-spreading disease that requires as fast a response as possible, like small-cell lung cancer (SCLC)?

For that, Medicaid may not make much of a difference, suggests one study.

The abstract “Medicaid Outcome Inequalities in Small-Cell Lung Cancer” was presented as part of a poster discussion at the IASLC 2019 North America Conference on Lung Cancer.

“We basically asked if there is any advantage to having (Medicaid) in a malignancy like small-cell lung cancer, which is a very aggressive malignancy for which you really need rapid access to highly-specialized, multi-disciplinary care,” said Stephen Chun, a radiation oncologist at MD Anderson Cancer Center, in a recent interview.

“The really surprising finding was that, for both limited stage and extensive stage small-cell lung cancer, there was absolutely no benefit to the Medicaid program compared to being uninsured,” added Chun.

The analysis involved outcomes of SCLC — which is generally more aggressive than the non-small-cell variety of tumors – in the United States National Cancer Database from 2004 to 2013.

Researchers examined a total of 181,784 cases, 38.6% of which were limited-stage tumors (LS-SCLC) and 60.2% of which were considered extensive-stage (ES-SCLC). The team used univariate analyses (UVA), multivariable analyses (MVA), and propensity score (PS) matching, according to the abstract.

For the LS-SCLC cases, Medicaid coverage showed similar survival when compared to the uninsured group on UVA (HR 1.02; 95% CI, 0.96-1.08; p=0.49).

Similarly, the ES-SCLC showed “no survival advantage” for Medicaid recipients over their uninsured counterparts (HR 1.00; 95% CI; 0.96-1.03, p=0.78).

The median survival was similar between the uninsured and Medicaid groups (14.4 vs. 14.1 months in LS-SCLC; p=0.167 and 6.3 months vs. 6.4 months for ES-SCLC; p=0.918), after PS matching.

The MVA analyses showed improved LS-SCLC survival for factors including: private/managed care insurance (HR 0.83; 95% CI; 0.78-0.87; p<0.001); Medicare insurance (HR 0.92; 95%CI; 0.88-0.97; p=0.002; and chemotherapy delivery (HR 0.62; 95% CI; 0.61-0.64; p<0.001).

The MVA also showed similar improved survival in the ES-SCLC patients for private/managed care, Medicare insurance, treatment at an academic or research program and chemotherapy, according to the research.

Chun said in the interview that resources may better be allocated in the future, considering the United States spends approximately $70 billion annually through combined federal and state investment in the Medicaid program.

“I’m not really out to indict the Medicaid program but I think there are clearly areas where Medicaid works — and maybe small-cell lung cancer might be an area where it really doesn’t work so well… that we really need to have targeted health care policy improvement,” he said.