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Broader systemic issues may still affect healthcare accessibility for certain populations. Despite the implementation of the Affordable Care Act, disparities remain in the time taken to initiate prostate cancer treatment. 

  • The Affordable Care Act aimed to reduce healthcare disparities.
  • Prostate cancer treatment delays increased despite the Affordable Care Act.
  • Non-White and Medicaid-insured men face higher risks of treatment delays.
  • Root causes of disparities in treatment initiation are multifaceted.

According to a study published in Cancer Medicine, the impact of the Affordable Care Act (ACA) on timely prostate cancer treatment initiation remains unclear. The study included 422,506 men diagnosed with intermediate- and high-risk prostate cancer between 2010 and 2016. Of these, 18,720 men experienced a delay of over 180 days in treatment initiation.

Key Findings: Racial and Insurance Disparities

Several notable findings of the study include the following:

  • Black patients had 1.79 times higher odds of treatment delay than White patients, while Hispanic patients had 1.37 times higher odds.
  • No significant difference in treatment delays was observed between those on Medicaid and the uninsured.
  • Patients with private insurance or Medicare were less likely to experience treatment delays.

Possible Reasons for Delays 

Possible reasons for the observed delays in treatment initiation include several contributing factors. Firstly, the ACA resulted in about 14 million newly insured patients. This sudden influx may have overburdened the existing healthcare system before it had a chance to adequately expand. Secondly, with an increased variety of treatment options available, patients might require more time to make treatment decisions with their providers. In addition, the extent to which the ACA has affected equity in healthcare access remains a topic of debate. 

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Broader Implications for Clinicians 

It’s imperative for healthcare providers to understand the significance of these findings. Delays in starting treatments, especially for patients with high-risk prostate cancer, may lead to serious consequences. Moreover, it’s evident that different healthcare systems show varying degrees of success when it comes to reforming and increasing equitable care. Therefore, structural barriers in the healthcare system, in addition to individual-level factors affecting patients, need to be examined to improve timely access to treatment. 

Healthcare providers have a responsibility to ensure patients, irrespective of their racial or insurance backgrounds, receive timely and effective treatment. Being aware of these disparities can help clinicians improve their patient care strategies and advocate for better systemic support.


Janopaul‐Naylor, J. R., Corriher, T. J., Switchenko, J., Hanasoge, S., Esdaille, A., Mahal, B. A., Filson, C. P., & Patel, S. A. (2023). Disparities in time to prostate cancer treatment initiation before and after the Affordable Care Act. Cancer Medicine, 12(17), 18258–18268. https://doi.org/10.1002/cam4.6419