{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T14:09:43Z","timestamp":1789049383040,"version":"build-2803163510"},"reference-count":17,"publisher":"American Association for Cancer Research (AACR)","issue":"12","funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["NU58DP007160"],"award-info":[{"award-number":["NU58DP007160"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["aacrjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,12,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>Medicaid expansion is associated with improvements in access to early detection and treatment services, and 2-year overall survival (OS) among individuals with cancer. However, the association with improvements in longer-term survival remains understudied. A difference-in-differences (DD) approach was used to examine changes in 5-year cause-specific survival and OS following Medicaid expansion. A total of 1,423,983 cancer cases diagnosed between 2007 and 2008 and 2014 and 2015 among adults 18 to 59 years of age residing in 26 expansion and 12 non-expansion states were included. Improvements in cause-specific survival were significantly greater in expansion states among individuals residing in rural [DD: 2.55 percentage point (ppt); 95% confidence interval (CI), 0.23\u20134.86] and high-poverty communities (DD: 1.54 ppt; 95% CI, 0.30\u20132.77), non-Hispanic White individuals (DD: 0.37 ppt; 95% CI, 0.05\u20130.70), and those with pancreatic (DD: 2.60 ppt; 95% CI, 0.86\u20134.34), lung (DD: 1.32 ppt; 95% CI, 0.30\u20132.34), and colorectal cancers (DD: 1.31 ppt; 95% CI, 0.26\u20132.37). Results were similar for OS. These findings underscore the importance of Medicaid expansion in mitigating disparities in survival outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance:<\/jats:title>\n                    <jats:p>Improvements in 5-year cause-specific survival and OS were greater in Medicaid expansion than non-expansion states among individuals residing in rural and high-poverty communities and among individuals diagnosed with cancers that generally have a worse prognosis, emphasizing the importance of Medicaid expansion in mitigating disparities in survival outcomes.<\/jats:p>\n                    <jats:p>See related commentary by Paskett, p. 2404<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1158\/2159-8290.cd-25-1244","type":"journal-article","created":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T04:03:06Z","timestamp":1759896186000},"page":"2431-2436","update-policy":"https:\/\/doi.org\/10.1158\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Association between Medicaid Expansion and 5-Year Survival among Individuals Diagnosed with Cancer"],"prefix":"10.1158","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-6849-0093","authenticated-orcid":false,"given":"Elizabeth J.","family":"Schafer","sequence":"first","affiliation":[{"name":"1Surveillance, Prevention, and Health Services Research, American Cancer Society, Atlanta, Georgia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0730-0877","authenticated-orcid":false,"given":"Christopher J.","family":"Johnson","sequence":"additional","affiliation":[{"name":"2Cancer Data Registry of Idaho, Boise, Idaho."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3407-9215","authenticated-orcid":false,"given":"Fabio Y.","family":"Moraes","sequence":"additional","affiliation":[{"name":"3Cancer Care and Epidemiology, Queen\u2019s University, Kingston, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7159-7949","authenticated-orcid":false,"given":"Xuesong","family":"Han","sequence":"additional","affiliation":[{"name":"1Surveillance, Prevention, and Health Services Research, American Cancer Society, Atlanta, Georgia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2733-2000","authenticated-orcid":false,"given":"Jingxuan","family":"Zhao","sequence":"additional","affiliation":[{"name":"1Surveillance, Prevention, and Health Services Research, American Cancer Society, Atlanta, Georgia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0000-4111","authenticated-orcid":false,"given":"Ahmedin","family":"Jemal","sequence":"additional","affiliation":[{"name":"1Surveillance, Prevention, and Health Services Research, American Cancer Society, Atlanta, Georgia."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1086","published-online":{"date-parts":[[2025,10,8]]},"reference":[{"key":"2025120203072376100_bib1","unstructured":"Kaiser Family Foundation\n          . Status of state medicaid expansion decisions. [cited 2025 Sept 10] Available from: https:\/\/www.kff.org\/status-of-state-medicaid-expansion-decisions\/#:\u223c:text=This%20page%20displays%20an%20interactive%20map%20of%20the,resources%20are%20listed%20%28with%20links%29%20below%20the%20map. Accessed2015 March 3."},{"key":"2025120203072376100_bib2","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1097\/MLR.0000000000000876","article-title":"Changes in health insurance coverage associated with the affordable Care Act among adults with and without a cancer history: population-based national estimates","volume":"56","author":"Davidoff","year":"2018","journal-title":"Med Care"},{"key":"2025120203072376100_bib3","doi-asserted-by":"crossref","first-page":"1713","DOI":"10.1001\/jamaoncol.2018.3467","article-title":"Comparison of insurance status and diagnosis stage among patients with newly diagnosed cancer before vs after implementation of the patient protection and affordable Care Act","volume":"4","author":"Han","year":"2018","journal-title":"JAMA Oncol"},{"key":"2025120203072376100_bib4","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.amepre.2019.02.015","article-title":"Changes in breast and colorectal cancer screening after Medicaid expansion under the affordable Care Act","volume":"57","author":"Fedewa","year":"2019","journal-title":"Am J Prev Med"},{"key":"2025120203072376100_bib5","doi-asserted-by":"crossref","first-page":"1176","DOI":"10.1093\/jnci\/djac077","article-title":"Association between medicaid expansion under the affordable Care Act and survival among newly diagnosed cancer patients","volume":"114","author":"Han","year":"2022","journal-title":"J Natl Cancer Inst"},{"key":"2025120203072376100_bib6","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1111\/jrh.12234","article-title":"Medicaid expansion under the affordable Care Act and insurance coverage in rural and urban areas","volume":"33","author":"Soni","year":"2017","journal-title":"J Rural Health"},{"key":"2025120203072376100_bib7","doi-asserted-by":"crossref","first-page":"1495","DOI":"10.1007\/s11606-018-4537-0","article-title":"Third year of survey data shows continuing benefits of Medicaid expansions for low-income childless adults in the U.S","volume":"33","author":"Cawley","year":"2018","journal-title":"J Gen Intern Med"},{"key":"2025120203072376100_bib8","doi-asserted-by":"crossref","first-page":"5963","DOI":"10.1016\/j.vaccine.2020.07.024","article-title":"The association between state Medicaid expansion and human papillomavirus vaccination","volume":"38","author":"Hoff","year":"2020","journal-title":"Vaccine"},{"key":"2025120203072376100_bib9","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1097\/MLR.0000000000000984","article-title":"Increased cancer screening for low-income adults under the affordable care act medicaid expansion","volume":"56","author":"Hendryx","year":"2018","journal-title":"Med Care"},{"key":"2025120203072376100_bib10","doi-asserted-by":"crossref","first-page":"e194","DOI":"10.1097\/AS9.0000000000000194","article-title":"Impact of Medicaid expansion under the affordable care act on receipt of surgery for breast cancer","volume":"3","author":"Elmore","year":"2022","journal-title":"Ann Surg Open"},{"key":"2025120203072376100_bib11","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.amjsurg.2019.06.023","article-title":"Disparities in access to cancer surgery after Medicaid expansion","volume":"219","author":"Mesquita-Neto","year":"2020","journal-title":"Am J Surg"},{"key":"2025120203072376100_bib12","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1377\/hlthaff.2017.1542","article-title":"Medicaid expansion and community health centers: care quality and service use increased for rural patients","volume":"37","author":"Cole","year":"2018","journal-title":"Health Aff (Millwood)"},{"key":"2025120203072376100_bib13","doi-asserted-by":"crossref","first-page":"e35879","DOI":"10.1002\/cncr.35879","article-title":"Impact of Medicaid expansion on racial disparities among patients with gastrointestinal cancer","volume":"131","author":"Manisundaram","year":"2025","journal-title":"Cancer"},{"key":"2025120203072376100_bib14","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1245\/s10434-021-10709-4","article-title":"Association of Medicaid expansion with pancreatic cancer treatment and outcomes: evidence from the national cancer database","volume":"29","author":"Fonseca","year":"2022","journal-title":"Ann Surg Oncol"},{"key":"2025120203072376100_bib15","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1016\/j.atssr.2024.04.034","article-title":"Impact and durability of the affordable care act medicaid expansion on lung cancer treatment","volume":"2","author":"Thosani","year":"2024","journal-title":"Ann Thorac Surg Short Rep"},{"key":"2025120203072376100_bib16","doi-asserted-by":"crossref","first-page":"m4087","DOI":"10.1136\/bmj.m4087","article-title":"Mortality due to cancer treatment delay: systematic review and meta-analysis","volume":"371","author":"Hanna","year":"2020","journal-title":"BMJ"},{"key":"2025120203072376100_bib17","doi-asserted-by":"crossref","first-page":"1285","DOI":"10.1002\/jso.27456","article-title":"Association of Medicaid expansion with 2-year survival and time to treatment initiation in gastrointestinal cancer patients: a National Cancer Database study","volume":"128","author":"Mobley","year":"2023","journal-title":"J Surg Oncol"}],"container-title":["Cancer Discovery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aacrjournals.org\/cancerdiscovery\/article-pdf\/doi\/10.1158\/2159-8290.CD-25-1244\/3656548\/cd-25-1244.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/aacrjournals.org\/cancerdiscovery\/article-pdf\/15\/12\/2431\/3684486\/cd-25-1244.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/aacrjournals.org\/cancerdiscovery\/article-pdf\/15\/12\/2431\/3684486\/cd-25-1244.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T08:07:32Z","timestamp":1764662852000},"score":1,"resource":{"primary":{"URL":"https:\/\/aacrjournals.org\/cancerdiscovery\/article\/15\/12\/2431\/767710\/Association-between-Medicaid-Expansion-and-5-Year"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,8]]},"references-count":17,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,10,8]]},"published-print":{"date-parts":[[2025,12,2]]}},"URL":"https:\/\/doi.org\/10.1158\/2159-8290.cd-25-1244","relation":{},"ISSN":["2159-8274","2159-8290"],"issn-type":[{"value":"2159-8274","type":"print"},{"value":"2159-8290","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,8]]}}}