Association of the Affordable Care Act With Receipt of Guideline‐Concordant Adjuvant Chemotherapy for Colon and Non‐Small Cell Lung Cancer

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BACKGROUND: Access to high-quality care, defined as receipt of guideline-concordant treatment, is crucial for cancer outcomes, and insurance coverage is an important determinant of such care. This study investigated the association between the Affordable Care Act (ACA), which expanded insurance coverage, and receipt of guideline-concordant adjuvant chemotherapy for non-small cell lung cancer (NSCLC) and colon cancer. METHODS: Our retrospective study includes data from Pennsylvania Cancer Registry for patients aged 26-64 with Stage 3 colon cancer or Stage IIB/Stage IIIA/Stage IIIB NSCLC between 2010-2019. Based on review of literature and National Comprehensive Cancer Network guidelines, we focused on receipt of adjuvant chemotherapy as our measure of guideline-concordant care. We employed interrupted time series analysis to assess changes in level and annual trend of receipt of adjuvant chemotherapy following ACA implementation. Analyses were performed overall and by subgroups defined by race/ethnicity, rurality, and ADI quartile. RESULTS: Across the study period, 83.9% of colon cancer and 61.7% of NSCLC patients received chemotherapy after surgery. Post-ACA, we observed a non-significant increase in annual rate (slope change) of post-operative colon cancer patients receiving guideline-concordant chemotherapy (+0.74 percentage points per year (pppy), p = 0.68), with larger, non-significant increases among non-White patients (+7.73 pppy, p = 0.16), rural residents (+9.74 pppy, p = 0.05), and those from ADI Q4 (high deprivation) neighborhoods (+3.92 pppy, p = 0.24). For NSCLC, there was a non-significant decrease in annual rate of receipt of guideline-concordant chemotherapy (-1.34 pppy, p = 0.30). CONCLUSIONS: There were no statistically significant trends in our primary models. Estimates suggest potential increases in receipt of guideline-concordant chemotherapy for post-operative colon cancer patients post-ACA, overall and among underserved groups, and potential decreases in receipt of guideline-concordant chemotherapy for NSCLC patients post-ACA, overall and among underserved groups. These findings warrant further study of linkages between comprehensive insurance coverage and disparities in colon cancer and NSCLC care and outcomes.

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