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Scientific Oral Presentations

Care Equity, Quality, and Safety

Session: Scientific Oral Presentations 1 - Care Equity, Quality, and Safety

The Impact of the Affordable Care Act on Laryngeal Carcinoma Outcomes: A National Cancer Data Base Study

Sunday, September 29, 2024
1:42 PM – 1:48 PM EDT
Location: MBCC, 224
Disclosure(s):
Margaret C. Nurimba, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Mark S. Swanson, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: The introduction of the Affordable Care Act (ACA) of 2010 aimed to improve access to care in the United States by expanding the population eligible for Medicaid coverage, and has been associated with decreased rates of uninsurance and increased likelihood of early head and neck cancer diagnosis. This study aims to assess the impact of ACA and expansion of Medicaid on disease presentation and overall survival for patients with laryngeal carcinoma.

Methods: This is a cross-sectional study of patients diagnosed with laryngeal squamous cell carcinoma (n = 28,885) between 2004-2018 in the National Cancer Database (NCDB). Demographics and disease presentation were evaluated using descriptive statistics. Overall survival (CS) was assessed with Cox proportional hazard regression analyses.

Results: The annual prevalence of laryngeal SCC in non-Expansion states increased from a mean of 588.5 annual cases pre-ACA (2004-2010) to 932.4 annual cases post-ACA (2010-2018). Expansion-states had a decrease in annual cases from a mean of 1,719 annual cases pre-ACA to 947.4 annual cases post-ACA. There was a statistically significant increase in Stage IV disease post-ACA for both non-expansion states (41.7% post versus 31.8% pre, p < 0.001) and expansion states (38.3% post versus 31.5% pre, p < 0.001). There was no significant difference in survival for patients diagnosed with laryngeal cancer post-ACA (HR 1.043, 95% CI 0.985 – 1.105) compared to pre-ACA in non-expansion states. Expansion states had improved survival pre-ACA (HR 0.937, 95% CI 0.893 – 0.983) and post-ACA (HR 0.916, 95% CI 0.863 - 0.973) compared to pre-ACA non-expansion states.

Conclusions: Increased access to care with the ACA led to increased diagnosis of laryngeal squamous cell cancer and increased diagnosis of late-stage disease. While there were significant differences in survival between expansion and non-expansion states, there were no significant difference in survival outcomes pre- and post-ACA. Further work is needed to understand the ACA’s long-term impact on achieving equitable laryngeal cancer care.

    Presenting Author(s)

  • MN

    Margaret C. Nurimba, MD

    Resident Physician
    University of Southern California
    Los Angeles, CA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Senior Author(s)

  • MN

    Margaret C. Nurimba, MD

    Resident Physician
    University of Southern California
    Los Angeles, CA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • Tamara N. Chambers, MD

    Associate Professor of Clinical Otolaryngology-Head and Neck Surgery
    Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California
    Los Angeles, CA, United States

    Disclosure information not submitted.

  • MS

    Mark S. Swanson, MD

    Associate Professor of Otolaryngology
    USC Caruso Department of Otolaryngology - Head and Neck Surgery
    los angeles, California, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.