TOPLINE:

Patients with resected Merkel cell carcinoma (MCC) living in Medicaid expansion states showed higher 5-year overall survival than those in nonexpansion states, despite having more adverse tumor features.

METHODOLOGY:

• Researchers analyzed 14,802 patients from the National Cancer Database (median age, 75-76 years; 94% White) with stages I-III MCC who underwent surgical resection (2010-2020).
• Overall, 60.9% of patients were residing in expansion states and 39.1% in nonexpansion states.
• Patients in the nonexpansion vs expansion states were more likely to have smaller tumor sizes (< 2 cm; 61.4% vs 56.9%; P = .003), negative nodal disease (72.6% vs 70.7%; P = .018), and lack of tumor lymphovascular invasion (66.4% vs 62.2%; P < .001).
• The primary outcome was overall survival (OS). Survival was also compared before (2010-2013) and after (2014-2020) implementation of Medicaid expansion.

TAKEAWAY:

• Five-year OS was higher among patients in expansion vs nonexpansion states for both stages I-II (61.4% vs 58.3%; P = .022) and stage III disease (46.9% vs 44.4%; P = .044).
• Survival improved after Medicaid expansion among all patients for both stages I-II (5-year OS, from 57.8% to 61.2%; P = .002) and stage III disease (5-year OS, from 42.1% to 47.8%; P < .001).
• Residence in an expansion state (hazard ratio [HR], 0.92; P = .02) and diagnosis after expansion implementation (HR, 0.87; P < .001) independently predicted improved survival.
• Older age, higher comorbidity burden, stage III disease, nodal involvement, lymphovascular invasion, and positive margins predicted worse survival.

IN PRACTICE:

The results “support a growing consensus” that Medicaid expansion “improves cancer outcomes through expanded access to care,” including patients with MCC, the authors concluded. “As national discourse continues regarding the future of Medicaid policy,” they added, “these findings provide timely evidence of the oncologic benefit of expanded insurance coverage, particularly for vulnerable, low-income populations.”

SOURCE:

The study was led by Yingjoy Li, University of California Irvine School of Medicine, and was published online on December 29 in the Journal of the American Academy of Dermatology.

LIMITATIONS:

The study was retrospective and lacked data on recurrence, cancer-specific mortality, and treatment timing.

DISCLOSURES:

The study did not receive any funding. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.