Association of the Affordable Care Act With Receipt of Guideline-Concordant Adjuvant Chemotherapy for Colon and Non-Small Cell Lung Cancer

Sep 22, 2026

Access to guideline-concordant cancer treatment is essential for improving outcomes, and insurance coverage is a key driver of treatment receipt. This retrospective study evaluates whether the Affordable Care Act (ACA), which expanded insurance coverage, is associated with receiving guideline-concordant adjuvant chemotherapy among patients with non-small cell lung cancer and colon cancer. Using Pennsylvania Cancer Registry data and interrupted time series analyses across 2010–2019, results show no statistically significant trends in primary models while suggesting potential subgroup differences.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages13

Reading Time33 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusions

Introduction

Cancer Medicine RESEARCH ARTICLE OPEN ACCESS Association of the Affordable Care Act With Receipt of Guideline-Concordant Adjuvant Chemotherapy for Colon and Non-Small Cell Lung Cancer Sriya Kudaravalli1 | Nicole Ober2 | Zhaojun Sun2 | Manisha Bhattacharya1 | Bruce L. Jacobs3 | Jonathan G. Yabes4,5 | Lindsay M. Sabik2 1University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA | 2Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA | 3Department of Urology, Division of Health Services Research, Pittsburgh, Pennsylvania, USA | 4Center for Biostatistics and Qualitative Methodology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA | 5Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA Correspondence: Lindsay M. Sabik ([lsabik@pitt.edu](lsabik@pitt.edu)) Received: 12 August 2025 | Revised: 8 June 2026 | Accepted: 1 July 2026 Keywords: adjuvant chemotherapy | affordable care act | cancer disparities | guideline-concordant care | insurance coverage ABSTRACT Background: Access to high-quality care, defined as receipt of guideline-concordant treatment, is crucial for cancer outcomes, and insurance coverage is an important determinant of such care. This study investigated the association between the Affordable Care Act (ACA), which expanded insurance coverage, and receipt of guideline-concordant adjuvant chemotherapy for non-small cell lung cancer (NSCLC) and colon cancer. Methods: Our retrospective study includes data from Pennsylvania Cancer Registry for patients aged 26–64 with Stage 3 colon cancer or Stage IIB/Stage IIIA/Stage IIIB NSCLC between 2010–2019. Based on review of literature and National Comprehensive Cancer Network guidelines, we focused on receipt of adjuvant chemotherapy as our measure of guideline-concordant care. We employed interrupted time series analysis to assess changes in level and annual trend of receipt of adjuvant chemotherapy following ACA implementation. Analyses were performed overall and by subgroups defined by race/ethnicity, rurality, and ADI quartile. Results: Across the study period, 83.9% of colon cancer and 61.7% of NSCLC patients received chemotherapy after surgery. Post-ACA, we observed a non-significant increase in annual rate (slope change) of post-operative colon cancer patients receiving guideline-concordant chemotherapy (+0.74 percentage points per year (pppy), p = 0.68), with larger, non-significant increases among non-White patients (+7.73 pppy, p = 0.16), rural residents (+9.74 pppy, p = 0.05), and those from ADI Q4 (high deprivation) neighborhoods (+3.92 pppy, p = 0.24). For NSCLC, there was a non-significant decrease in annual rate of receipt of guidelineconcordant chemotherapy (−1.34 pppy, p = 0.30) . Conclusions: There were no statistically significant trends in our primary models. Estimates suggest potential increases in receipt of guideline-concordant chemotherapy for post-operative colon cancer patients post-ACA, overall and among underserved groups, and potential decreases in receipt of guideline-concordant chemotherapy for NSCLC patients post-ACA, overall and among underserved groups. These findings warrant further study of linkages between comprehensive insurance coverage and disparities in colon cancer and NSCLC care and outcomes. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. © 2026 The Author(s). Cancer Medicine published by John Wiley & Sons Ltd. Cancer Medicine, 2026; 15:e72093 1 of 13 [https://doi.org/10.1002/cam4.72093](https://doi.org/10.1002/cam4.72093) 1 | Introduction Cancer is the second leading cause of death in the US and the leading cau

FAQs

What is the study’s primary question regarding the Affordable Care Act (ACA)?

The study examines whether the ACA is associated with receipt of guideline-concordant adjuvant chemotherapy for non-small cell lung cancer and colon cancer.

What data and time period are used in the analysis?

The research uses Pennsylvania Cancer Registry data for patients aged 26–64 with specified cancer stages between 2010 and 2019, analyzed using interrupted time series methods.

What outcomes were measured as “guideline-concordant care”?

Receipt of adjuvant chemotherapy following surgery was used as the measure of guideline-concordant treatment.

Did the study find statistically significant changes after ACA implementation?

No statistically significant trends were found in the primary models, though estimates suggested potential subgroup changes for colon cancer and NSCLC.

Sep 22, 2026

Upload by Anna Hans