(P 130) THE ADOPTION OF MEDICAID EXPANSION IN THE AFFORDABLE CARE ACT IS NOT ASSOCIATED WITH STAGE AT PRESENTATION OR 5-YEAR OVERALL SURVIVAL FOR BONE OR SOFT TISSUE SARCOMAS

Objective: Despite significant advances in healthcare in the United States, inequity persists. The primary purpose of the 2010 Patient Protection and Affordable Care Act (ACA) was to address this inequity by increasing access to healthcare for uninsured individuals by subsidizing private insurance and, in participating states, by expanding Medicaid insurance. Patients with private and Medicaid coverage are more likely than those without insurance to receive preventative care and cancer screening. Uninsured patients are more likely to be diagnosed with late-stage cancer.

Implementation of the ACA has been associated with higher rates of early-stage diagnosis and improved mortality for a number of cancers types. Early-stage diagnosis of bone and soft tissue sarcomas improved significantly in states that adopted Medicaid expansion compared to states that did not. However, Medicaid patients with bone and soft tissue sarcomas have been shown to have reduced disease-specific survival, higher rates of distant metastases, and higher rates of amputation compared to those with non-Medicaid insurance. To date, the implications of Medicaid expansion on long-term sarcoma survival have not been assessed.

The purpose of this study was to assess the association of Medicaid expansion on stage at presentation and 5-year overall survival (OS) for bone and soft tissue sarcomas.

Methods: The National Cancer Database (NCDB) is the largest cancer registry in the world and offers validated, standardized collection methods that are crucial for the accurate investigation of cancer outcomes. We queried the NCDB for all patients diagnosed with bone and soft tissue sarcomas from 2011-2013 and 2015-2022 residing in states that either expanded Medicaid on January 1, 2014 or did not expand Medicaid. Year of diagnosis, state of diagnosis, age, race/ethnicity (non-Hispanic white, non-Hispanic black, Hispanic, or other/unknown), and Charlston/ Deyo comorbidity index were abstracted. Additionally, zip code, median household income, and high school attainment were used to categorize patients into quartiles based on US Census data.

Outcomes of interested included stage at presentation and 5-year OS.

A difference-in-difference analysis was used for evaluating stage, and a multivariable Cox proportional hazards analysis was used to assess OS.

Results: For soft tissue sarcoma, living in a state that opted into expansion was associated with a small improvement in 5-year OS (p=0.008) all times points; however, the implementation of the expansion itself in 2014 was not temporally associated with stage at presentation or improvements in 5-year OS as a discrete (pre- and post-2014) or continuous variable.

For bone sarcoma, none of the studied variables were associated with stage at presentation or 5-year OS.

Conclusion: For bone and soft tissue sarcomas, the adoption of Medicaid expansion as part of the ACA is not associated with changes in stage at presentation or 5-year OS. Investigation into the reasons for better 5-yr OS both pre- and post-expansion for patients residing in states that chose to adopt Medicaid expansion is warranted to improve survival for sarcoma patients.