A new study led by our faculty reports that living in a state with expanded Medicaid is associated with improved pancreatic cancer survival at one year; however, this benefit was not experienced uniformly across race and gender.

The study, “Impact of Medicaid Expansion on Pancreatic Cancer: An Examination of Sociodemographic Disparity in 1-Year Survival,” leveraged data from more than 35,000 patients nationwide and was published in the Journal of the American College of Surgeons. The paper was also selected for podium presentation at the American College of Surgeons Clinical Congress in October 2021. The efforts were led by Erin M. Mobley, Ph.D., M.P.H., an assistant professor in the division of general surgery and surgical oncology in the department of surgery and affiliate member of the Center for Health Equity and Engagement Research, or CHEER.

The multidisciplinary team of authors primarily focused on the impact of Medicaid expansion on pancreatic cancer survival after accounting for other factors that could also influence patients’ survival times (e.g., race, insurance, rurality, social deprivation). The authors also explored the impact of Medicaid expansion on pancreatic cancer survival within key subgroups. The group noted that the overall beneficial effect of Medicaid expansion on pancreatic cancer survival was not apparent across all groups. Most notably, there was no beneficial effect of living in a state that expanded Medicaid for black males or black females with pancreatic cancer.

These results suggest the existence of equity issues with respect to access to Medicaid expansion and underscore the importance of the type analysis the investigators performed. According to Dr. Mobley, “If we had stopped with just the overall analysis, we would have concluded that expanding Medicaid improves pancreatic cancer survival and missed the most important part of this story. That is, while our results suggest there is a benefit, this is not equally experienced across all categories of race. These are the exact type of inequities that we can and must continue to identify and explore.”

The study also generated invited commentary from Aaron M. Delman, M.D., M.S., which was published in tandem and included this observation:

“As a community of surgeons and researchers committed to mitigating disparity in care, we must further investigate the patient experience to identify actionable policies and protocols for improvement. Prospective, qualitative and quantitative research with a focus on including diverse populations by race and ethnicity, rurality and insurance status are warranted to better understand the barriers to care beyond access that impact patient survival from pancreas cancer. This work by Mobley and colleagues may serve as a foundation for understanding the impact of Medicaid expansion in pancreatic cancer broadly, but it should also be a springboard for identifying and mitigating subsequent barriers to care experienced by minority patients.”

MORE WORK AHEAD 

This study is a great example of our ability and mission to leverage multidisciplinary teams to push research that asks the right questions and seeks answers that are inclusive and equitable. Our challenge now is exploring the broader goal the commentator noted to the readership and forge ahead.

It’s clearly not enough to just repair an inequity in access to care via health insurance. It will take much more to provide equitable outcomes for underserved populations. It’s a matter of lifestyle, economic wellbeing, education, nutrition, and so many other barriers – some of which we know and others we have yet to identify. The research will continue for Dr. Mobley and her team, thanks to their determination to fully understand the factors that contribute to positive outcomes for patients with pancreatic cancer and other types of cancer as well.

“Just improving access to insurance through Medicaid expansion isn’t enough to fix the problem. There are many other ways we need to mitigate this – which is precisely what we are doing now and will continue to do in the future,” said Dr. Mobley. “Plus, we’re starting to look at other cancers; those like cancers of the colon, breast and bladder that are more amenable to screening and early detection. Ultimately, we want to better understand how we can improve survival and quality of life, not only for those with pancreatic cancer, but those with other cancers. There are seemingly endless numbers of ways to analyze the data and unique methods to use, such as leveraging implementation science. It’s fascinating and provides so many possibilities for significant change in the way we deliver care.”

CHEER was established in 2020 to facilitate such in-depth studies with the goal of leading to greater health equity. It is a combined effort of the Office of Research Affairs and the Office of Inclusion, Diversity, Equity and Access at the University of Florida College of Medicine – Jacksonville. We look forward to the great work that’s ahead.