BACKGROUND Health reform and the merits of Medicaid expansion remain at the top of the legislative agenda, with growing evidence suggesting an impact on cancer care and outcomes. A systematic review was undertaken to assess the association between Medicaid expansion and the goals of the ACA in the context of cancer care. The purpose of this paper is to summarize the currently published literature and to determine the effects of Medicaid expansion on outcomes during points along the cancer care continuum. METHODS A systematic search for relevant studies was performed in the PubMed/MEDLINE, EMBASE, Scopus and Cochrane databases. Three independent observers used an abstraction form to code outcomes and perform a quality and risk of bias assessment using predefined criteria. RESULTS 48 studies were identified. The most common outcomes assessed were the impact of Medicaid expansion on insurance coverage (23.4% of studies), followed by evaluation of racial and/or socioeconomic disparities (17.4%) and access to screening (14.5%). Medicaid expansion was associated with increases in coverage for cancer patients and survivors, as well as reduced racial- and income-related disparities. CONCLUSIONS Medicaid expansion has led to improved access to insurance coverage among cancer patients and survivors, particularly among low-income and minority populations. This review highlights important gaps in the existing oncology literature, including a lack of studies evaluating changes in treatment and access to end-of-life care following implementation of expansion.

中文翻译：

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《平价医疗法案》的医疗补助扩展及其对癌症护理连续体的影响：系统回顾。

背景 医疗改革和扩大医疗补助的优点仍然是立法议程的首要议题，越来越多的证据表明医疗改革和医疗补助对癌症治疗和结果的影响。我们进行了一项系统审查，以评估医疗补助扩张与 ACA 在癌症护理方面的目标之间的关联。本文的目的是总结当前发表的文献，并确定医疗补助扩张对癌症护理连续过程中各个阶段结果的影响。方法 在 PubMed/MEDLINE、EMBASE、Scopus 和 Cochrane 数据库中系统检索相关研究。三个独立观察员使用抽象形式对结果进行编码，并使用预定义的标准进行质量和偏差风险评估。结果 确定了 48 项研究。最常见的评估结果是医疗补助扩大对保险覆盖范围的影响（23.4％的研究），其次是对种族和/或社会经济差异的评估（17.4％）和获得筛查的机会（14.5％）。医疗补助的扩大与癌症患者和幸存者覆盖范围的扩大以及种族和收入相关差异的缩小有关。结论 医疗补助的扩大改善了癌症患者和幸存者，特别是低收入和少数族裔人群获得保险的机会。该综述强调了现有肿瘤学文献中的重要差距，包括缺乏评估扩展实施后治疗和临终关怀的变化的研究。