Implementation of the Affordable Care Act may have led to a significant increase in the number of Hispanic breast cancer patients treated in California at a National Cancer Institute (NCI)-designated cancer center. Further, there was also an increase reported in the number of Hispanic women who consented to participate in a national breast cancer clinical trial. Both findings are based on a study presented at the 9th American Association for Cancer Research (AACR) Conference on The Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved, held September 25–28 in Fort Lauderdale.
“From both scientific and ethical standpoints, it is critical to have diverse patient populations represented in clinical trials; therefore, it is important to examine the effects of health-care policies and practices to identify both barriers and facilitators that patients encounter in seeking and/or being offered participation in clinical trials,” said Chloe Lalonde, who was Clinical Research Coordinator at the University of California San Diego Moores Cancer Center at the time of this study and is now a medical student at Emory University School of Medicine.
Uptick in Treatment, I-SPY 2 Participation
Following the implementation of the Affordable Care Act in California on January 1, 2014, Ms. Lalonde and colleagues observed a higher proportion of Hispanic women with breast cancer receiving care at the cancer center and participating in the I-SPY 2 clinical trial. I-SPY 2 is a multicenter clinical trial of neoadjuvant chemotherapy in combination with investigational agents for women with a new breast cancer diagnosis.
“We postulated that this increase in patients was due to the fact that previously uninsured patients were now insured and could receive care at our cancer center. We then proposed that this increase might also be true for clinical trial participation,” Ms. Lalonde said.
These findings suggest that policy decisions such as enacting the Affordable Care Act can have a measurable impact on patients seeking treatment for their cancer and provide them with more options of where to receive cancer care, Ms. Lalonde noted. Moores Cancer Center, along with other NCI-designated cancer centers around the country, does not routinely accept uninsured patients.
Further, an increase in the enrollment of Hispanics in the screening phase of the I-SPY 2 trial is encouraging evidence of improved equitability in the clinical trial recruitment process, she added.
In this study, the researchers assessed the number of Hispanic women receiving care for a new breast cancer diagnosis at the cancer center between January 2010 and December 2013, before the implementation of the Affordable Care Act, and between January 2014 and December 2015, after the implementation of the Affordable Care Act. They also looked into the cohort of patients who signed up to be screened in order to participate in the I-SPY 2 clinical trial during the same time periods.
The team found that there was a statistically significant increase in the number of Hispanic women with breast cancer who came to the cancer center for care after implementation of the Affordable Care Act. Hispanic women represented 10.1% of the Moores Cancer Center breast cancer patient population between January 2010 and December 2013, which went up to 13.7% between January 2014 and December 2015; there was also an increasing trend over this time period: 11.5% in 2014 and 16.0% in 2015.
Further, the number of Hispanic women who consented to participate in the clinical trial also increased significantly. Prior to January 2014, Hispanic women represented 11.7% of I-SPY 2 screening consents; since 2014, the proportion of Hispanic women increased to 22.2%. A nearly sixfold increase in the percentage of Hispanic women who were Spanish-speaking was also observed, from 2.3% to 13.9%.
“California enrolled 3.3 million people during the first 6 months of open enrollment. Initially, enrollment among Hispanics was slow due to limited resources tailored to language and culture, but as resources increased via community-level outreach, enrollment increased,” Ms. Lalonde said.
A limitation of this study is that the findings come from a small number of patients at one NCI-designated cancer center. It will be important for other cancer centers located in regions where the Affordable Care Act has been implemented to see if they observe similar results in their underserved populations, Ms. Lalonde reported. ■
1. Lalonde C. Unkart J, Wallace A, et al: Can the Affordable Care Act result in increasing enrollment of minority patients into therapeutic clinical trials at NCI‐designated Cancer Centers? 9th American Association for Cancer Research Conference on The Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved. Presented September 27, 2016.