Changes in treatment trends in the early glottic cancer population after the Affordable Care Act

BACKGROUND The clinical impact of Medicaid expansion in otolaryngology is uncertain. Herein, we evaluate the impact of Medicaid expansion on treatment patterns (primary radiotherapy vs surgery) in the early glottic cancer population. METHODS Data regarding adults with Tis-T2N0M0 glottic cancer that were treated with either surgery or radiotherapy between January 2010 and December 2016 were obtained from the Surveillance, Epidemiology, and End Results (SEER) cancer database. Changes in treatment trends and survival in the Medicaid expansion setting were discerned. RESULTS The proportion of patients undergoing radiotherapy decreased from 64.8% to 59% after the Patient Protection and Affordable Care Act (PPACA) was implemented. State Medicaid expansion status was associated with reduced odds of radiation therapy (odds ratio [OR] = 0.66). Patients were diagnosed more often with earlier stage disease (20.6% vs 17.0% T2 diagnoses) in the Medicaid expansion cohort. CONCLUSION The implementation of the PPACA was associated with a significant increase in surgical therapy for and earlier diagnosis of glottic cancer.