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Breaking Down The Results From LUNGevity’s Scorecard

Last updated: March 2020

In its Lung Cancer Scorecard, LUNGevity Foundation grades each state on its access to care and lung cancer statistics. Based on their analysis, over half of the states receive a grade below a C. The scores reveal specific ways to improve access to care and treatment for lung cancer.1,2

What is LUNGevity’s Lung Cancer Scorecard?

Advances in early detection and treatment for lung cancer have only slightly improved lung cancer survival rates. LUNGevity Foundation is dedicated to increasing this progress by funding lung cancer research and improving access to care. To understand each state’s delivery of lung cancer care, LUNGevity graded each state on its Lung Cancer Scorecard. They assigned each state a performance score based on five factors:

1. Coverage for lung cancer screening

Lung cancer screening is done before symptoms arise, usually using low-dose computed tomography (LDCT). It is covered under Medicare and commercial insurance, but not mandated under Medicaid. It has been proven to reduce the number of deaths from lung cancer.3 LUNGevity awarded 1 point to states whose Medicaid covers lung cancer screening.4

2. Coverage for biomarker testing

Lung cancer treatment has been improved by tests to determine if a therapy will work for a specific person. This relies on a biomarker to predict someone’s likely response. For lung cancer, one biomarker is a protein called programmed death-ligand 1 (PD-L1). People with high levels of PD-L1 may benefit from immunotherapy. Testing for biomarkers is covered by Medicare and commercial insurers, but not by Medicaid. LUNGevity awarded 1 point to states whose Medicaid covers biomarker testing.

3. Medicaid expansion

Medicaid expansion under the Affordable Care Act (ACA) extended Medicaid eligibility to cover more low-income Americans. Not every state chose to expand Medicaid. However, Medicaid expansion is linked to improved access to cancer care. LUNGevity awarded 1 point to Medicaid expansion states.5

4. Lung cancer incidence

According to the most recent data in 2018, the national average lung cancer incidence rate was 59.6 per 100,000 people. For this scorecard, LUNGevity awarded 1 point to states whose incidence rate was below this average.6

5. Lung cancer survival

The 5-year survival rate is the percentage of people alive 5 years after lung cancer diagnosis. The national average is 21.7 percent (up from 17.2 percent a decade ago). LUNGevity awarded 1 point to states whose survival rate was above this average.6

Combining these factors, 5 points translates to an A, 4 points for a B, 3 points for a C, 2 points for a D, and 1 or 0 points for an F.

What were the state-by-state findings?

Analysis of Medicaid coverage showed that one-third of states do not cover lung cancer screening. And only 40 percent provide coverage for biomarker testing. As of January 2020, 14 states have not expanded Medicaid. States with expanded Medicaid tend to have better coverage policies and more favorable incidence and survival rates.

As for lung cancer incidence rate, 27 states are above the national average. Utah has the best rate, while Kentucky has the worst. As for lung cancer survival rate, 33 states are at or below the national average. Connecticut has the best rate, while Alabama has the worst.

States in the Northeast and West tend to have better coverage policies and increased Medicaid expansion. This translates to more favorable incidence and survival rates compared to the Midwest and South. Only 4 states received an A grade: Maryland, Minnesota, Oregon, and Washington.

How can we improve lung cancer survival?

This study reveals a strong connection between Medicaid coverage policy and lung cancer outcomes. Based on this, LUNGevity proposes several solutions:

  1. States should improve coverage for lung cancer screening and biomarker testing. This would greatly benefit public health.
  2. Coverage for routine costs of clinical trials is another way states can improve. State policies should remove obstacles to inclusion and promote clinical trial involvement.
  3. Increased dialogue with state Medicaid agencies could benefit the population. This is possible with only slight changes to coverage policy and related costs.1

Learn more in LUNGevity’s Lung Cancer Scorecard.

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