ACA Adoption Led to Increases in Earlier Diagnosis, Treatment of Ovarian Cancer

Implementation of the Affordable Care Act (ACA) led to earlier diagnosis and treatment among women under 65 years of age with ovarian cancer, according to a study presented at the 2019 American Society of Clinical Oncology Annual Meeting.

Although women treated for ovarian cancer in earlier stages have higher chances of survival, early-stage ovarian cancer is often difficult to detect. Because early symptoms are typically subtle, it can take years for a patient to be diagnosed. The likelihood of surviving 5 years or more falls to less than 30% for women who are diagnosed at an advanced stage compared with more than 75% for women diagnosed with early-stage disease, according to the study. Improving rates of early diagnosis is key to increasing survival odds and access to health insurance can lead to greater rates of early diagnosis.

The study authors aimed to determine whether ACA implementation was associated with more diagnoses of early-stage ovarian cancer. After the ACA was signed into law, health coverage increased as the proportion of uninsured Americans dropped from 15% in early 2010 to 12% by 2016.

For the study, the researchers used the National Cancer Database to divide women diagnosed with ovarian cancer into 2 age groups: 35,842 women with the disease pre-ACA (2004 to 2009) and 37,145 women post-ACA (2011 to 2014) aged 21 to 64 years compared with 28,895 women pre-ACA and 30,604 women post-ACA aged 65 years and older.

To compare changes over time between the 2 groups, the researchers used a difference in differences (DD) approach. According to the analysis, there was a relative gain of 1.7% in early-stage diagnosis of ovarian cancer and a relative improvement of 1.6% in treatment within 30 days of diagnosis compared with women aged 65 years and older. Publicly-insured women post-ACA aged 21 to 64 years additionally saw relative gains of 2.5% in early-stage diagnosis and timely treatment, the study found.

Overall, the researchers concluded that the ACA was associated with more early diagnoses and treatment receipt 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,” the study authors wrote.

Lead study author Anna Jo Smith, MD, MPH, resident in the Johns Hopkins Department of Gynecology and Obstetrics, noted that the findings are significant for the 22,000 women diagnosed with ovarian cancer in the United States annually. According to Smith, a 1.7% difference means that approximately 400 more women could be diagnosed at an early stage.

“Detecting and treating ovarian cancer at an early stage saves lives and lower health care costs compared to treatment of care at a more advanced, incurable stage,” Smith said in a statement about the study results. “Having health insurance plays a major role in whether or not a woman has access to care providers who can monitor symptoms and act on those symptoms if necessary.”

References

Earlier Ovarian Cancer Diagnoses and Treatment Seen After ACA Implementation [news release]. American Society of Clinical Oncology. https://www.asco.org/about-asco/press-center/news-releases/earlier-ovarian-cancer-diagnoses-and-treatment-seen-after-aca. Accessed June 3, 2019.

Smith AJ, Nickels A. Impact of the Affordable Care Act on early-stage diagnosis and treatment for women with ovarian cancer. J Clin Oncol 37, 2019 (suppl; abstr LBA5563).