Studies look at the effects of health insurance coverage, medical debt, and incarceration on health outcomes.
Since celebrating our Discovery accomplishments in 2023 and detailing the findings of the new ACS Cancer Facts & Figures report earlier this year, the ACS Discovery pillar has announced several new publications and news updates.
Medical debt associated with worse health status, in new ACS findings
Researchers stress need for better access to affordable medical care to improve population health.
New findings, announced March 4, led by ACS researchers shows medical debt was associated with more days of poor physical and mental health, more years of life lost, and higher mortality rates for all-cause and leading causes of death at the county level in the United States. The study is published in the Journal of the American Medical Association (JAMA) Network Open.
“Patients are increasingly burdened by high out-of-pocket costs for health care in the U.S. including problems paying medical bills and medical debt, but little was known about county-level associations of medical debt with population health,” said Dr. Xuesong Han, lead author of the study and scientific director of health services research at the American Cancer Society. “Our findings reinforce medical debt as an important social determinant of health, which, unfortunately, may threaten public health in the country.”
“This study reiterates how the rising cost of health care in the U.S. continues to take a significant toll on patients and their families,” noted Lisa Lacasse, president of the American Cancer Society Cancer Action Network (ACS CAN). “With a system that continues to be unaffordable for too many touched by cancer, addressing medical debt is a growing public policy priority among cancer patients and survivors. We need lawmakers at all levels of government to take action to make health care more affordable and address medical debt now."
Dr. Robin Yabroff is senior author of the study. Other ACS researchers involved in this report include Dr. Xin Hu, Dr. Zhiyuan Zheng and Kewei Sylvia Shi.
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People with incarceration history less likely to receive health care in the US
Interventions needed to help increase access to important health care, including cancer screenings, researchers say.
A new study, announced Feb. 23, led by ACS researchers shows people with an incarceration history had worse access to and receipt of healthcare, including physical exams, blood pressure, blood sugar and cholesterol tests, as well as dental check-ups and breast and colorectal cancer screenings compared with people without incarceration history in the United States. The findings are published in the Journal of the American Medical Association (JAMA) Health Forum.
“Our study results were not surprising as people with a history of incarceration experience barriers in access to health care in the U.S.,” said Jingxuan Zhao, senior associate scientist, health services research at the American Cancer Society and lead author of the study. “However, the findings further highlight the need for efforts to identify interventions to help increase receipt of recommended preventive services for this vulnerable population.”
"Affordable health insurance is critical for everyone. As this study demonstrates, health insurance is a critical factor to reduce disparities in cancer screening for people who have been incarcerated,” said Lisa A. Lacasse, president of ACS CAN. “Medicaid is an important source of health insurance for thousands of people who would not otherwise have access to care, including those who have been released from incarceration and are transitioning back to their communities. We urge lawmakers in these 10 states have not expanded Medicaid to do so and help save more lives from cancer."
Dr. Leticia Nogueira is senior author of the study. Other ACS authors include Jessica Star, Dr. Xuesong Han, Dr. Zhiyuan Zheng, Dr. Qinjin Fan, Sylvia Kewei Shi, and Dr. Robin Yabroff.
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ACS and St. Baldrick’s Foundation award $720K in grants
Research focused on advancing childhood cancer treatments.
ACS and St. Baldrick’s Foundation announced on Feb. 16 they have awarded $720,000 in Pilot Accelerator grants meant to fill the funding gap in clinical trials focused on childhood cancer patients. These grants require researchers use biospecimens and data collected in clinical trials to accelerate the progression of new treatment options. The following investigators and institutions were each awarded $240,000 grants for two-year projects:
- Kathrin Bernt, MD, The Children’s Hospital of Philadelphia, Title: Venetoclax for infant ALL – COG AALL2321
- Challice Bonifant, MD, PhD, Johns Hopkins University School of Medicine, Title: Donor NK cell therapy for pediatric myeloid malignancies
- Linda Resar, MD, Johns Hopkins University School of Medicine, Title: Targeting the HMGA1 Epigenome and Downstream Networks in MLL-r Leukemia
In the first round of Accelerator grants awarded in 2021, six grants totaling $3 million were awarded to fund research focused on neuroblastoma, pediatric ALL, and AML. In the second year, five grants totaling $1.2 million were awarded to focus on chemotherapy treatment outcomes in lymphoma patients, immunotherapy development to treat leukemia and lymphoma, and gliomas, a deadly and difficult to treat pediatric cancer. Projects in this third cohort of grantees will focus on testing the addition of the new drug venetoclax to the treatment of infant acute lymphoblastic leukemia (ALL) with chemotherapy and immunotherapy, improving the treatment and sustaining remission for pediatric high-risk acute myeloid leukemia (AML), and developing new therapies for mixed lineage leukemia (MLL)- rearranged leukemia.
Patients with cancer who suffered a major adverse financial event more likely to be diagnosed with advanced stage disease
New research shows ‘understanding patients’ financial vulnerability within healthcare settings may inform efforts to improve equitable access to oncology care.’
New findings, announced Feb. 6, led by researchers at ACS and the National Cancer Institute (NCI) show more than one-third of cancer patients had a major adverse financial event – bankruptcy, lien, or eviction – before their cancer diagnosis. These patients with adverse financial events (AFEs) had a later-stage diagnosis compared with patients with no events. The findings are published in the Journal of Clinical Oncology (JCO).
“Patients with a previous AFE not only face greater likelihood of more advanced cancer but also may encounter substantial barriers to receiving recommended care and experience worse health outcomes for their newly diagnosed cancer because of their pre-existing financial vulnerability,” said Dr. Robin Yabroff, scientific vice president, health services research at the American Cancer Society and senior author of the study.
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Medicaid expansion improves post-surgery survival among adults with non-small cell lung cancer
Researchers emphasize importance of healthcare coverage and timely access to care for vulnerable populations.
In a new, national, hospital-based study, announced Jan. 12, researchers at ACS found that Medicaid expansion was associated with a statistically significant reduction in early mortality following surgical resection of stage I-III non-small cell lung cancer (NSCLC). The study results indicate that access to health insurance coverage via Medicaid expansion in the United States during a crucial period – in this case, during recovery from major surgery – is associated with improved survival. The findings are published in the Journal of the American Medical Association (JAMA) Network Open.
“Lung cancer is the second most commonly diagnosed cancer in the U.S. and the leading cause of cancer-related mortality, but Medicaid expansion can help improve access to lifesaving care,” said Dr. Leticia Nogueira, scientific director, health services research at the American Cancer Society and lead author of the study. “This study quantifies the impact of Medicaid expansion on survival among vulnerable patient populations, demonstrating the importance of healthcare coverage and access to timely care.”
“This study is further proof that expanding Medicaid saves lives,” said Lisa Lacasse, president of ACS CAN. “We know what we need to do to end cancer as we know it for everyone, most critically of which is that people with cancer have access to the care they need - including the crucial types of post-operative care this study analyzes. Medicaid expansion helps ensure more people have that access and a better chance of surviving cancer, which is why ACS CAN has long advocated for this evidence-based policy. ACS CAN continues to urge the 10 states who have yet to increase Medicaid eligibility to expand access quickly. Lives are at stake.”
Dr. Robin Yabroff is senior author of the study. Other ACS authors include Dr. Ahmedin Jemal and Dr. Xuesong Han.
Health Insurance coverage at cancer diagnosis varies substantially by state, new study shows
ACS researchers highlight Medicaid expansion for the increase in insurance coverage.
A new study, announced Jan. 11, led by ACS researchers shows substantial state variations in health insurance coverage, which is a strong determinant of cancer care access and survival, among newly diagnosed cancer patients in the United States. These findings come despite a significant increase over the past decade in insurance coverage under the Affordable Care Act, which increases coverage options for working-age adults. The research is published in the journal Health Affairs Scholar.
“Having health insurance coverage is crucial to ensure timely access to quality cancer treatment and survivorship care,” said Dr. Xuesong Han, scientific director, health services research at the American Cancer Society and senior author of the study. “The findings reinforce the importance of the expansion of Medicaid income eligibility under the Affordable Care Act, playing a big role in access to care and helping to save lives.”
“This study is further proof that expanding Medicaid increases access to comprehensive health insurance and we know that alone can increase the chances that cancer is diagnosed early which in turn augments the likelihood that someone survives the disease. In short, expanding this health insurance program is saving lives,” said Lisa Lacasse, president of ACS CAN. “ACS CAN has been a long-time advocate for Medicaid expansion to reduce the cancer burden and continues to work tirelessly in the 10 states that have not yet increased their Medicaid program eligibility.”
Other ACS authors include Nova Yang, Dr. Qinjin Fan and Dr. Robin Yabroff.
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Discovery news briefs
ACS research work was noted in publications and received recognition.
- ACS and Flatiron Health announced on March 6, the recipients of the Fourth Annual Real-World Data Impact Awards. Grantees will receive funding and data to research key questions for patients with advanced cancers and their related outcomes.
The first Cancer Prevention Research Conference will be held this June in Boston, MA. Stay tuned to ACS2Go for more information on this event.
