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  • br Finally while we collected


    (8). Finally, while we collected the available data through 2014, the effects of the ACA will likely continue, particu-larly with the expansion of additional states in 2015.
    Left unanswered by the current research is whether or not insurance rates influenced the utilization of brachyther-apy in expanded states, and what specific patient outcomes related to the receipt (or lack thereof) of brachytherapy may have changed with insurance status. Unfortunately, such questions cannot be completely answered by the SEER registries due to the aforementioned underascertainment of Ko 143 services, the lack of local control data, and the lack of financial toxicity information. Nonetheless, all these issues are of high interest for future work.
    Patients who received brachytherapy were less likely to be uninsured in states where Medicaid was expanded under the ACA in 2014. There was no significant change in insurance status in nonexpanded states. The reduction in uninsurance 
    in expanded states was particularly evident in regions with highest poverty levels. These results should help inform policy decisions and efforts to ensure that all cancer patients have ac-cess to high quality treatments, such as brachytherapy.
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    [17] Churilla T, Egleston B, Dong Y, et al. Disparities in the management and outcome of cervical cancer in the United States according to health insurance status. Gynecol Oncol 2016;141:516e523.
    [18] Moss HA, Havrilesky LJ, Chino J. Insurance coverage among women diagnosed with a gynecologic malignancy before and after implemen-tation Ko 143 of the affordable care act. Gynecol Oncol 2017;146:457e464. Accepted Manuscript
    Original Article
    Changes in life expectancy for cancer patients over time since diagnosis
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