{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T01:02:28Z","timestamp":1778893348995,"version":"3.51.4"},"reference-count":34,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,10,5]],"date-time":"2023-10-05T00:00:00Z","timestamp":1696464000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The impact of Medicaid expansion (ME) on the treatment of patients with cancer remains controversial, especially individuals requiring complex multidisciplinary care. We sought to evaluate the impact of Medicaid expansion (ME) on receipt of multimodal care, including surgical resection, for Stage I\u2013III biliary tract cancer (BTC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients diagnosed with BTC between 40 and 65 years of age were identified from the National Cancer Database and divided into pre\u2010 (2008\u20132012) and post\u2010 (2015\u20132018) ME cohorts. Difference\u2010in\u2010difference (DID) analysis was used to determine the impact of ME on the utilization of surgery and multimodal chemotherapy and\/or radiotherapy treatment for BTC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 12,415 patients with BTC (extrahepatic, <jats:italic>n<\/jats:italic>\u2009=\u20095622, 45.3%; intrahepatic, <jats:italic>n<\/jats:italic>\u2009=\u20094352, 35.1%; gallbladder, <jats:italic>n<\/jats:italic>\u2009=\u20091944, 15.7%; overlapping, <jats:italic>n<\/jats:italic>\u2009=\u2009497, 4.0%), 5835 (47.0%) and 6580 (53.0%) patients were diagnosed before versus after ME, respectively. Overall utilization of surgery (OR 1.13, 95% CI 1.02\u20131.26) and multimodality therapy (OR 1.13, 95% CI 1.01\u20131.27) increased in states that adopted ME. Utilization of surgery among uninsured\/Medicaid patients in ME states increased relative to patients living in non\u2010ME states (\u2206+10.1%, <jats:italic>p<\/jats:italic>\u2009=\u20090.01). Similarly, the use of multimodal treatment increased among uninsured\/Medicaid patients living in ME versus non\u2010ME states (\u2206+6.4%, <jats:italic>p<\/jats:italic>\u2009=\u20090.04); in contrast, there were no difference among patients with other insurance statuses (overall: \u2206+1.5%, private: \u2206\u22122.0%, other: \u2206+3.9%, all <jats:italic>p<\/jats:italic>\u2009&gt;\u20090.5). Uninsured\/Medicaid patients with BTC who lived in a ME state had a lower risk of long\u2010term death in the post\u2010ME era (HR 0.81, 95% CI 0.67\u20130.98; <jats:italic>p<\/jats:italic>\u2009=\u20090.03).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Implementation of ME positively impacted survival among patients who underwent surgical and multimodal treatment for Stage I\u2013III BTC.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jso.27478","type":"journal-article","created":{"date-parts":[[2023,10,5]],"date-time":"2023-10-05T19:49:08Z","timestamp":1696535348000},"page":"233-243","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Impact of Medicaid expansion on the multimodal treatment of biliary tract cancer"],"prefix":"10.1002","volume":"129","author":[{"given":"Belisario","family":"Ortiz Rueda","sequence":"first","affiliation":[{"name":"Department of Surgery The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7187-0124","authenticated-orcid":false,"given":"Yutaka","family":"Endo","sequence":"additional","affiliation":[{"name":"Department of Surgery The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3676-9263","authenticated-orcid":false,"given":"Diamantis I.","family":"Tsilimigras","sequence":"additional","affiliation":[{"name":"Department of Surgery The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henrique","family":"Araujo Lima","sequence":"additional","affiliation":[{"name":"Department of Surgery The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center Columbus Ohio USA"},{"name":"Department of Surgery Federal University of Minas Gerais School of Medicine Belo Horizonte Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad Musaab","family":"Munir","sequence":"additional","affiliation":[{"name":"Department of Surgery The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Selamawit","family":"Woldesenbet","sequence":"additional","affiliation":[{"name":"Department of Surgery The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary","family":"Dillhoff","sequence":"additional","affiliation":[{"name":"Department of Surgery The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1387-2604","authenticated-orcid":false,"given":"Aslam","family":"Ejaz","sequence":"additional","affiliation":[{"name":"Department of Surgery The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jordan","family":"Cloyd","sequence":"additional","affiliation":[{"name":"Department of Surgery The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7994-9870","authenticated-orcid":false,"given":"Timothy M.","family":"Pawlik","sequence":"additional","affiliation":[{"name":"Department of Surgery The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,10,5]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2020.02.068"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers15092628"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2018.12.001"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers15133312"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.21037\/cco.2016.10.03"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11605-022-05496-6"},{"key":"e_1_2_6_8_1","unstructured":"PubL.Patient protection and Affordable Care Act of 2010.2010."},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2017.1491"},{"key":"e_1_2_6_10_1","unstructured":"Kaiser Family Foundation.Status of state action on the Medicaid expansion decision. 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