Expanding Medicaid Improves Outcomes in Gynecologic Malignancies, But is it Enough?

Abstract

Approximately 100,000 women each year in the United States are diagnosed with gynecologic cancers of the uterus, ovary, cervix, vulva, or vagina. 1 Surgical management is a mainstay of treatment for most cases of gynecologic cancers, many of which also require adjuvant chemotherapy, immunotherapy, and/or radiation therapy. In 2014, states were given the option of expanding Medicaid eligibility, creating population-level differences in access to insurance across the United States. Huepenbecker et al. evaluated the effect of Medicaid expansion on shortterm postoperative outcomes by studying 30-and 90-day postoperative mortality in patients with gynecologic cancers. 2 In this retrospective cohort design using the National Cancer Database (NCDB), the authors performed an analysis of postoperative mortality trends before and after the 2014 Medicaid expansion in states that enacted the expansion (expansion states) compared with states that did not (non-expansion states), using a quasi-experimental difference-in-difference model. Appropriate checks to ensure the requisite assumption of parallel trends were performed, as well as a comparison of pre-and post-2014 postoperative mortality outcomes using univariate and multivariate analyses.A 46% decreased odds of 30-day postoperative mortality for endometrial cancer was found in expansion states compared with non-expansion states on difference-in-difference analysis, and this trend held true in subgroup Ó Society of Surgical Oncology 2022 First