Hughes, Kakra

INTRODUCTION: Non-Hodgkin's Lymphoma (NHL) survival is influenced by various factors, including marital status and sex. This study explores how these intersecting factors affect cancer-specific (CSS) and overall survival (OS) in NHL patients. OBJECTIVE: To examine the intersection of sex and marital status on survival outcomes among individuals with NHL. METHODOLOGY: We conducted a retrospective cohort study using SEER registry data for individuals aged 18-85 diagnosed with NHL. Cox regression models assessed the influence of marital status and sex on CSS and overall survival OS, adjusting for age, race, household income, disease stage, primary site, and treatment (chemotherapy, radiotherapy, surgery). Kaplan-Meier curves and log-rank tests compared survival distributions. RESULT: The study analyzed 319,013 individuals with NHL from 2000 to 2020. Participants were predominantly white (73.0%) and female (54.7%), with 54.6% married and a median age of 66 years (IQR 55-76). Females exhibited a 33% higher hazard of death for cancer-specific survival (HR = 1.34, 95% CI: 1.30-1.38) and a 40% higher hazard for overall survival (HR = 1.40, 95% CI: 1.37-1.44). The interaction of marital status and sex significantly impacts both CSS and OS among individuals with NHL. Widowed individuals, regardless of sex, showed the highest risk of death; males had a cancer-specific hazard ratio (HR) of 2.50 (95% CI: 2.35-2.65) and overall HR of 2.31 (95% CI: 2.21-2.41), while females had a cancer-specific HR of 3.09 (95% CI: 2.87-3.31) and overall HR of 2.97 (95% CI: 2.82-3.12). Divorced and separated individuals also exhibited elevated risk. Notably, married males had the lowest hazard ratios, with cancer-specific HR of 1.07 (95% CI: 1.03-1.12) and overall HR of 0.87 (95% CI: 0.84-0.89). CONCLUSION: This study highlights that marital status and sex significantly influence survival outcomes in NHL patients. Widowed individuals have the highest mortality risk, while being married is associated with better survival, especially for males. These findings emphasize the role of social support and gender-specific factors in NHL prognosis.

INTRODUCTION Medicaid expansion under the Affordable Care Act (ACA) has aimed to improve healthcare access and outcomes for low-income individuals across the United States. Acute Lymphoblastic Leukemia (ALL), a rapidly progressing hematological malignancy, demands timely and comprehensive medical intervention to optimize patient survival rates. Despite advancements in treatment, disparities in cancer-specific survival persist (CSS), particularly among socioeconomically disadvantaged populations. OBJECTIVE This study investigates the impact of Medicaid expansion on CSS among individuals diagnosed with ALL, aiming to explore the extent to which increased healthcare access through Medicaid expansion may influence survival outcomes in this vulnerable patient population. METHODOLOGY We utilized the Surveillance, Epidemiology, and End Results (SEER) cancer registry to examine the impact of Medicaid expansion on CSS among individuals diagnosed with ALL. A difference-in-difference analysis (DID) was conducted to evaluate the effect of the policy on survival outcomes. Texas, a state that has not implemented Medicaid expansion, was compared with California, which adopted the policy in 2014. The analysis adjusted for significant covariates including age, sex, race/ethnicity, socioeconomic status, and treatment modalities. By comparing pre- and post-expansion periods in these two states, we aimed to isolate the impact of Medicaid expansion on CSS in ALL patients. RESULT Among 22,303 patients, 60.0% were in California (13,384), while 40.0% were in Texas (8,919). The pre-ACA period included 14,129 patients (62.0% in California and 38.0% in Texas), and 8,174 patients were in the post-ACA period (56.6% in California and 43.4% in Texas). In the post-ACA implementation period, there was a 23.5% reduction in the hazard of deaths (HR=0.77, 95% CI 0.70-0.85). Medicaid expansion significantly improved cancer-specific survival among individuals with ALL across different race/ethnicity and income levels (DID=-0.69, 95% CI -1.18 to -0.19). The most significant improvements were observed among minority groups: Blacks (DID=-0.80, 95% CI -1.39 to -0.21) and Hispanics (DID=-0.72, 95% CI -1.35 to -0.22), as well as individuals with lower income levels (DID=-0.66, 95% CI -1.14 to -0.18). CONCLUSION The implementation of the ACA and its Medicaid expansion component led to a substantial improvement in cancer-specific survival among individuals with acute lymphoblastic leukemia in California compared to non-expansion Texas.