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Palliative Therapies in Metastatic Pancreatic Cancer: Does Medicaid Expansion Make a Difference?

  • Pancreatic Tumors
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Abstract

Background

The aim of this study was to evaluate the impact of medicaid expansion (ME) on receipt of palliative therapies in metastatic pancreatic cancer patients.

Patients and Methods

A difference-in-differences (DID) approach was used to analyze patients with metastatic pancreatic cancer identified from the National Cancer Database diagnosed during two time periods: pre-expansion (2010–2012) and post-expansion (2014–2016). Patients diagnosed while residing in ME states were compared with those in non-ME states. Multivariable logistic regression was used to identify predictors of receipt of palliative therapies.

Results

Of 87,738 patients overall, 7483(18.1%) received palliative therapies in the pre-expansion, while 10,211(21.5%) received palliative therapies in the post-expansion period. In the pre-expansion period, treatment at a high-volume facility (HVF) (odds ratio [OR] 1.10, 95% confidence interval [CI] 1.02–1.18) and non-west geographic location were predictive of increased palliative therapies. In the post-expansion period, treatment at an HVF (OR 1.09, 95% CI 1.02–1.16), geographic location, and living in an ME state at the time of diagnosis (OR 1.14, 95% CI 1.06–1.22) were predictive of increased palliative therapies. Older age, highest quartile median income (zip-code based), and treatment at a nonacademic facility were independently associated with decreased palliative therapies in both periods. DID analysis demonstrated that patients with metastatic pancreatic cancer living in ME states had increased receipt of palliative therapies relative to those in non-ME states (DID = 2.68, p < 0.001).

Conclusions

The overall utilization of palliative therapies in metastatic pancreatic cancer is low. Multiple sociodemographic disparities exist in the receipt of palliative therapies. ME is associated with increased receipt of palliative therapies in patients with metastatic pancreatic cancer.

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Authors and Affiliations

  1. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Hamza Khan MD & Fabian M. Johnston MD, MHS

  2. Department of Surgery, The University of South Alabama, Mobile, AL, USA

    Deepa Cherla MD, Martin J. Heslin MD, MSHA & Annabelle L. Fonseca MD, MHS

  3. Department of Psychology, The University of South Alabama, Mobile, AL, USA

    Krista Mehari PhD

  4. Kellogg School of Management, Northwestern University, Chicago, IL, USA

    Manish Tripathi BE, MBA

  5. Department of Internal Medicine, The University of South Alabama, Mobile, AL, USA

    Thomas W. Butler MD & Errol D. Crook MD

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  1. Hamza Khan MD
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  2. Deepa Cherla MD
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Correspondence to Annabelle L. Fonseca MD, MHS.

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Khan, H., Cherla, D., Mehari, K. et al. Palliative Therapies in Metastatic Pancreatic Cancer: Does Medicaid Expansion Make a Difference?. Ann Surg Oncol 30, 179–188 (2023). https://doi.org/10.1245/s10434-022-12563-4

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