Utilization of cancer-directed surgical therapy in Medicaid patients with cancer: comparison between low/intermediate/high-risk surgeries.

[INTRODUCTION] It is unknown whether underutilization of cancer-directed surgery (CDS) in patients with Medicaid contributes to worse overall survival (OS) across various operative risk spectrum in comparison to non-Medicaid patients.

[METHOD] The SEER database linked to Medicaid enrollment files between 2006 and 2013 was used. Spectrum of operative risks included pancreatic ductal adenocarcinoma (PDAC)-high-risk, colon cancer (CC)-intermediate-risk, or melanoma-low-risk. Multivariable Cox proportional-hazard and logistic regression analyses were used.

[RESULTS] There were 7,595 Medicaid and 163,416 non-Medicaid patients. Being in Medicaid was associated with higher odds of not undergoing CDS for CC (OR 1.88, 95% CI 1.41-2.52) and PDAC (OR 2.20, 95% CI 1.73-2.80). Correspondingly, not undergoing CDS was associated with worse survival (CC-HR 4.76, 95% CI 3.82-5.93; PDAC-HR 2.40, 95% CI 2.21-2.60) in Medicaid group vs non-Medicaid group. For melanoma, there was a larger impact of not undergoing CDS on OS in Medicaid compared to non-Medicaid population (HR 1.75, 95% CI 1.07-2.89).

[CONCLUSION] Across cancers with different operative risks, increasing the use of CDS may help reduce the OS gaps between Medicaid and non-Medicaid population.