Effect of the Affordable Care Act on Cervical Cancer Survival Rates in Californian Women [ID 2683402

Abstract

INTRODUCTION: Following the Affordable Care Act (ACA), insurance coverage among women in California surged. While ACA aimed to boost health care access and utilization, whether this has improved cancer-specific survival rates for cervical cancer patients remains questioned. In the present study, we evaluate the effect of the Affordable Care Act (ACA) on cancer-specific survival rates among women with cervical cancer by comparing pre-ACA (2000–2009) and post-ACA (2010–2020) periods. METHODS: This study utilized data from the Surveillance, Epidemiology, and End Results (SEER) Registry from 2000 to 2020. We bifurcated the study duration into pre-ACA (2000–2009) and post-ACA (2010–2020). The primary outcome investigated was cancer-specific survival between these periods. Our objective was to assess the effect of ACA's implementation on cancer-specific survival among women diagnosed with cervical cancer. Analytical adjustments were made for patient age, race/ethnicity, disease stage at presentation, income, marital status, and metropolitan residence status. We also considered whether cervical cancer was the primary site and incorporated treatment modalities such as curative surgery, radiotherapy, and chemotherapy into our analysis. RESULTS: Of 29,402 cervical cancer patients, 15,962 were diagnosed pre-ACA and 13,440 post-ACA. More women over 50 were diagnosed post-ACA (49.4%) than pre-ACA (44.9%). Late-stage diagnoses rose slightly post-ACA (42.7% versus 40.8%). Curative surgery decreased post-ACA (53.7% from 62.7%), but chemotherapy increased (48.6% from 39.9%). After adjusting for treatment modalities, post-ACA survival rates in California mirrored those of the pre-ACA period (hazard ratio [HR] 1.06; 95% CI, 0.98–1.15). CONCLUSION: The implementation of the ACA led to notable changes in treatment patterns and demographics for cervical cancer patients in California. Although health care access increased, cancer-specific survival rates were similar to the pre-ACA period when adjusting for treatment modalities.