Sriya Kudaravalli, a third-year medical student at the University of Pittsburgh School of Medicine, has been making waves with her research on how the Affordable Care Act (ACA) has impacted access to colon cancer treatment for underserved populations.
Kudaravalli, who recently was selected to present at the 17th American Association for Cancer Research Conference on Cancer Health Disparities, highlighted the association of the ACA insurance expansions with receipt of guideline-concordant colon cancer care.
“We chose colon cancer specifically because it is the second-leading cause of cancer-related deaths in the United States,” Kudaravalli explains.
Kudaravalli's research analyzed data from more than 3,000 stage 3 colon cancer patients between 2010-2019 who reside in Pennsylvania. The procedure compared pre- and post-ACA treatment patterns across several variables, including age, sex, race/ethnicity, and deprivation index quartile. For stage 3 colon cancer, guideline-concordant care includes adjuvant chemotherapy and the surgical removal of affected lymph nodes—both of which are crucial for improving survival and reducing the risk of recurrence. The findings reveal a marked improvement in care for patients who historically faced barriers to treatment.
“There was a statistically significant increase in guideline-concordant treatment for colon cancer post-Affordable Care Act among non-White patients, patients from rural areas and the most deprived neighborhoods” in Pennsylvania, Kudaravalli adds.
Post-ACA, access to guideline-concordant care increased by an average of 7.8% per year for non-white patients, 7.7% for rural patients, and 3.5% for those in the most socioeconomically disadvantaged areas.
Kudaravalli's work is particularly timely as debates over Medicaid expansion continue in the United States. “States that haven’t yet expanded Medicaid should seek to do so because they are missing an opportunity to improve access to guideline-concordant treatment for cancer, which is associated with better quality care and, in turn, with better outcomes,” said Kudaravalli.
Looking ahead, Kudaravalli plans to investigate how the ACA has affected care for non-small cell lung cancer and prostate cancer. She explains that while there are barriers currently preventing underserved groups from receiving equitable cancer, policymakers can work to develop the necessary provider decision support tools and patient education.
“Having a better understanding of the association of insurance coverage with receipt of guideline-concordant care for underserved groups across various cancers will enable us to better advocate for policy changes so that underserved groups can receive more equitable cancer care, which can reduce health disparities,” she says.
photo courtesy of Sriya Kudaravalli