Impact of the Affordable Care Act on early-stage diagnosis and treatment for women with ovarian cancer.

Abstract

LBA5563 Background: The 2010 Affordable Care Act (ACA) expanded access to insurance and care for many Americans. Our objective was to evaluate the impact of the ACA on stage at diagnosis and time to treatment for women with ovarian cancer. Methods: We utilized a difference-in-differences (DD) approach to assess stage at diagnosis and time to treatment before and after the 2010 ACA among women with ovarian cancer ages 21-64 years compared to women ages 65 years and older. We used the National Cancer Database with the 2004-2009 surveys as the pre-reform years and the 2011-2014 surveys as the post-reform years. Outcomes were analyzed for women overall and by insurance type, adjusting for patient race, living in a rural area, area-level household income and education level, Charlson co-morbidity score, distance traveled for care, Census region, and care at an academic center. Results: A total of 35,842 ovarian cancer cases pre-reform and 37,145 post-reform were identified for women 21-64 years compared with 28,895 cases pre-reform and 30,604 post-reform for women 65 years and older. The ACA was associated with increased early-stage diagnosis for women 21-64 years compared to women 65 and older with ovarian cancer (DD=1.7%, p-for-trend=0.001). Additionally, the ACA was associated with more women receiving treatment within 30 days of ovarian cancer diagnosis (DD=1.6%, p<0.001). Specifically, among women with public insurance, the ACA was associated with a significant improvement in early-stage diagnosis and receipt of treatment within 30 days of diagnosis (DD=2.5%, p=0.003 and DD=2.5%, p=0.006). Improvements in stage at diagnosis and time to treatment were seen across race, income, and education groups. Conclusions: Under the Affordable Care Act, women with ovarian cancer were more likely to be diagnosed at an early stage and receive treatment within 30 days of diagnosis. As stage and treatment are major determinants of survival, these gains under the ACA may have long-term impacts on women with ovarian cancer.