Abstract PR007: Impact of the Affordable Care Act on receipt of guideline-concordant care for colon cancer
Authors: Kudaravalli Sriya , Ober Nicole , Sun Zhaojun , Bhattacharya Manisha , Jacobs Bruce , Sabik Lindsay 
Published: September 2024

Abstract
Background: Colon cancer is the second-leading cause of cancer-related deaths in the U.S. Access to high-quality care, as determined by receipt of guideline-concordant treatment, is crucial for cancer outcomes. Insurance coverage is an important determinant of receipt of guideline-concordant cancer treatment, and lack of coverage contributes to disparities in health outcomes. This study investigated the effect of the Affordable Care Act (ACA), which expanded insurance coverage for non-elderly adults, on receipt of guideline-concordant colon cancer care, overall and for underserved groups. Methods: Our retrospective study includes data from the Pennsylvania Cancer Registry for 3290 patients aged 26-64 diagnosed with Stage 3 colon cancer (identified using SEER Summary Staging) between 2010-2019 who reside in Pennsylvania. We used a review of the literature and NCCN guidelines to establish criteria for guideline- concordant care for stage 3 colon cancer, which consists of adjuvant chemotherapy and resection of affected regional lymph nodes. We conducted an interrupted time series analysis comparing receipt of guideline-concordant care among patients diagnosed with stage 3 colon cancer pre- and post-ACA implementation across several socioeconomic variables, including age, sex, race/ethnicity, insurance status, community type, and area deprivation index (ADI) quartile. Underserved groups were identified as those who live in higher ADI quartiles, who identify as non-Hispanic Black and Hispanic, or who live in rural areas. Results: Across the study period, 82.8% of patients received guideline-concordant care. Patients in the sample ranged in age (8.7% &lt;=40; 21.9%, 41-50; 47.4%, 51-60; and 22.0%, 61-64). Slightly more than half (54.5%) were male; 79.8% were non-Hispanic White, 14.0% non-Hispanic Black; and 3.6% Hispanic. Most (87.9%) lived in urban areas; 7.5% in large towns; 2.5% in small towns; and 2.1% in rural areas. Insurance coverage in the sample was primarily private (63.7%), with 10.5% covered by Medicare, 11.9% by Medicaid, and 13.8% either uninsured or of other/unknown insurance status. Based on standardized mean differences, the above variables are balanced pre- and post-ACA. Receipt of guideline-concordant care increased post-ACA by 7.7% on average per year (p=0.0244) among patients in rural areas; by 3.5% on average per year (p=0.036) among patients from ADI Q4 (the most disadvantaged) neighborhoods; and by 7.8% on average per year (p=0.0135) among non-White patients. Conclusions: There was a statistically significant increase in guideline-concordant care for colon cancer post-ACA among non-White patients and patients from rural areas and the most deprived neighborhoods (ADI Q4) in Pennsylvania. The ACA is associated with an increase in the quality of colon cancer care for underserved groups, indicating that availability of comprehensive insurance coverage is important for reducing disparities in cancer care and outcomes.
Citation Format: Sriya Kudaravalli, Nicole Ober, Zhaojun Sun, Manisha Bhattacharya, Bruce Jacobs, Lindsay Sabik. Impact of the Affordable Care Act on receipt of guideline-concordant care for colon cancer [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr PR007.