Evidence map›Paper›PMID 40045146›Full record

ArticleAnnals of surgical oncology2025

Medicaid Expansion is Associated with Differences in Local Therapy for Non-small Cell Lung Cancer.

Isheeta Madeka, Shale J Mack, Hamza Rshaidat, Anurag Ishwar, Scott Koeneman, Sneha Alaparthi, Gregory L Whitehorn, Anie Ho, Tyler R Grenda, Nathaniel R Evans and 1 more

Abstract read
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Article in Annals of surgical oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

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4 · The record

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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Isheeta MadekaDivision of Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA. ixm219@jefferson.edu.
Shale J MackSidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
Hamza RshaidatDivision of Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Anurag IshwarSidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
Scott KoenemanDivision of Biostatistics and Bioinformatics, Thomas Jefferson University, Philadelphia, PA, USA.
Sneha AlaparthiDivision of Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Gregory L WhitehornSidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
Anie HoSidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
Tyler R GrendaDivision of Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Nathaniel R EvansDivision of Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Olugbenga T OkusanyaDivision of Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundMedicaid expansion under the Affordable Care Act aimed to expand healthcare access, improve quality, and reduce costs. The effects of Medicaid expansion on receipt of local therapy for lung cancer are unknown.

methodsWe utilized the National Cancer Database to conduct a retrospective analysis of patients with clinical T1-2, N0, M0 non-small cell lung cancer (NSCLC) without neoadjuvant treatment. Patients living in Medicaid expansion states as of January 2014 were compared with patients in non-expansion states between 2010 and 2013 (pre-expansion) and 2016 and 2019 (post-expansion). A difference-in-difference (DID) analysis was used to compare rates of surgery and stereotactic body radiation therapy (SBRT).

resultsAmong 149,966 patients, there were 80,514 patients (53.6%) in Medicaid non-expansion states and 69,452 patients (46.3%) in expansion states. Receipt of local therapy (surgery or SBRT) {- 1.6% vs. - 2.8%, DID 1.24% [confidence interval (CI) 0.45-2.02%]} and receipt of surgery (- 7.9% vs. - 9.3%, DID 1.4% [0.46-2.4%]) decreased at a lesser rate in expansion states between 2010-2013 and 2016-2019. Among patients with Medicaid, receipt of local therapy (surgery or SBRT) and surgery increased at a greater rate in expansion states with a stronger treatment effect (18.9% vs. 1.1%, DID 7.8% [76.12-9.4%]; 8.1 vs. 0.12%, DID 8.0% [6.3-9.66%]). Patients who traveled >10 miles decreased at a greater rate in expansion states (3.7% vs. 5.1%, DID - 1.5% [- 2.46 to - 0.35%]).

conclusionBased on Medicaid expansion status, states have different changes in local therapy rates for NSCLC. Our data suggest that Medicaid expansion may increase healthcare access in the receipt of first-line treatment for early-stage NSCLC.

Indexed as

Carcinoma, Non-Small-Cell LungHealth Services AccessibilityLung NeoplasmsMedicaidPatient Protection and Affordable Care ActRadiosurgeryAgedFemaleFollow-Up StudiesHumansMaleMiddle AgedPneumonectomyPrognosisRetrospective StudiesUnited StatesInsuranceLung cancerMedicaidSBRTSurgery

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.