An Affordable Care Act (ACA) provision that allowed young adults to be covered under their parents' insurance led to a shift to earlier-stage diagnosis and more timely receipt of adjuvant chemotherapy among young colorectal cancer patients, according to a American Cancer Society study, 'Colorectal Cancer Care among Young Adult Patients after the Dependent Coverage Expansion under the Affordable Care Act', published in the Journal of the National Cancer Institute.
In September 2010, the Dependent Coverage Expansion (DCE) under the ACA allowed young adults up to age 26 to be covered under their parents' private health insurance. To find out whether the DCE was associated with improved care among young adults with colorectal cancer, investigators led by Dr Leticia Nogueira, analysed outcomes for 1,924 newly-diagnosed colorectal cancer patients who were DCE-eligible (ages 19 to 25) and compared outcomes to 8,313 who were not (ages 27 to 34) using the National Cancer Database during 2007-2013.
The researchers found DCE-eligible patients who had surgery for stage IIB-IIIC colorectal cancer were 34% more likely to receive adjuvant chemotherapy post-ACA than pre-ACA. Furthermore, among DCE-eligible patients, average time from surgery to chemotherapy decreased by seven days; from 57.4 days pre-ACA to 50.4 days post-ACA (p=0.01). There was no change among the comparison group (those ineligible for DCE). The authors note that because the younger age groups were too young to be eligible for routine colorectal cancer screening, the change likely reflect improved access to care that allows for timely assessment of early symptoms.
"Our results have important implications for young adults diagnosed with colorectal cancer who may experience interruptions in their insurance coverage due to loss of dependent coverage or other life transitions," the authors noted. "Our findings highlight the role of the ACA in improving access to potentially life-saving cancer care, including a shift to early-stage diagnosis and more timely receipt of adjuvant chemotherapy."