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Grant Details

Grant Number: 5R03CA259665-02 Interpret this number
Primary Investigator: Ji, Xu
Organization: Emory University
Project Title: Understanding the Impact of the Affordable Care Act on Cancer Treatment and Outcomes for Adolescents and Young Adults (AYA)
Fiscal Year: 2022


Adolescents and young adults (AYAs; diagnosed with cancer at ages 15-39 years) have lagged in improvements in cancer survival seen among younger and older populations. A major barrier to improvement in cancer outcomes is the lack of access to healthcare, historically associated with the high rates of uninsurance in this age group. Uninsurance also drives the sociodemographic (racial/ethnic, socioeconomic, urban-rural) disparities in cancer survival, overall and among AYA populations. The Affordable Care Act (ACA) provides an option for states to expand Medicaid coverage to adults with income ≤138% of the federal poverty level. Expanding Medicaid coverage can reduce uninsurance in young adults, as well as in adolescents via extending coverage to their adult parents. To date, there has been no prior study to examine the impact of the ACA Medicaid expansion on increasing access to cancer care or its association with early detection, timely treatment, and survival improvement in AYAs. We will utilize the National Cancer Database (NCDB) to examine a cohort of ~246,000 AYAs diagnosed with cancer between 2010 and 2016 across all US states and D.C. The national AYA cohort will allow a rigorous, quasi-experimental approach to determine the net effect of the ACA Medicaid expansion on the timeliness, outcome, and equity of cancer care for AYAs with the 8 most common cancers (female breast cancer, testis cancer, melanoma, colorectal cancer, thyroid cancer, cervical cancer, Hodgkin lymphoma, and non-Hodgkin lymphoma). The NCDB captures >80% of all new AYA cancer cases in the US, and will enable us to generate nationwide estimates of the impact of the ACA Medicaid expansion on cancer outcomes, including time to treatment initiation and survival. In addition, we will evaluate the cohort pre and post Medicaid expansion by sociodemographic factors (race/ethnicity, socioeconomic status, urban-rural) to underline disparate outcomes. This research will inform policy interventions for cancer control toward reducing disparities in AYA cancer.


Medicaid expansion is associated with treatment receipt, timeliness, and outcomes among young adults with breast cancer.
Authors: Ji X. , Shi K.S. , Ruddy K.J. , Zhao J. , Mertens A.C. , Yabroff K.R. , Castellino S.M. , Han X. .
Source: JNCI cancer spectrum, 2023-08-31; 7(5), .
PMID: 37707583
Related Citations

Survival in Young Adults With Cancer Is Associated With Medicaid Expansion Through the Affordable Care Act.
Authors: Ji X. , Shi K.S. , Mertens A.C. , Zhao J. , Yabroff K.R. , Castellino S.M. , Han X. .
Source: Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2023-04-01; 41(10), p. 1909-1920.
EPub date: 2022-12-16.
PMID: 36525612
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Moving Beyond Patient-Level Drivers of Racial/Ethnic Disparities in Childhood Cancer.
Authors: Ji X. , Sohn H. , Sil S. , Castellino S.M. .
Source: Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 2022-06-01; 31(6), p. 1154-1158.
PMID: 35642393
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Narrowing Insurance Disparities Among Children and Adolescents With Cancer Following the Affordable Care Act.
Authors: Ji X. , Hu X. , Castellino S.M. , Mertens A.C. , Yabroff K.R. , Han X. .
Source: JNCI cancer spectrum, 2022-01-05; 6(1), .
PMID: 35699500
Related Citations

Association of Medicaid Expansion With Cancer Stage and Disparities in Newly Diagnosed Young Adults.
Authors: Ji X. , Castellino S.M. , Mertens A.C. , Zhao J. , Nogueira L. , Jemal A. , Yabroff K.R. , Han X. .
Source: Journal of the National Cancer Institute, 2021-11-29; 113(12), p. 1723-1732.
PMID: 34021352
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