Medicaid Expansion Status and Receipt of Palliative Care in Stage IV Oral Cavity Cancer.

Objective: Early and integrated palliative care (PC) interventions are recommended for advanced-stage cancers. The rate with which patients with stage IV oral cavity squamous cell carcinoma (OCSCC) receive PC as part of their oncologic care is unknown. We sought to understand the utilization of PC for patients with stage IV OCSCC in Medicaid expanded versus non-expanded states. Study Design: Retrospective cohort. Setting: National Cancer Database was queried for patients with stage IV OCSCC from 2004 to 2017. Methods: Patients in Medicaid expanded (EXP) states were categorized as pre-expansion (pre-EXP) or post-expansion (post-EXP). Patients in nonexpanded states (NEXP) were categorized as diagnosed before 2014 (pre-NEXP) or during/after 2014 (post-NEXP). Multivariable logistic regressions were used to compare receipt of PC among pre-EXP and post-EXP patients, and separately among post-EXP and post-NEXP cases. Results: Among 15,356 patients who met inclusion criteria, 629 (4.10%) received PC. There was a trend towards increased receipt of PC in post-EXP compared to pre-EXP cases, but this did not reach statistical significance. Among pre-EXP and post-EXP cases, patients were more likely to receive PC with the lowest income quartile, tongue cancer as the oral cavity subsite, and no insurance. Conclusion: There was no significant difference of PC receipt for patients with stage IV OCSCC in Medicaid expanded versus non-expanded states. Results among patients in pre-EXP and post-EXP states suggest increased PC use among more disadvantaged patient groups. Further analysis on receipt of PC in vulnerable patient populations with advanced-stage cancer is warranted.