CALIFORNIA AND MASSACHUSETTS BEST PLACES FOR CANCER CARE IN USA

California and Massachusetts are best in the nation when it comes to meeting the needs of patients with cancer and establishing and enforcing policies that address cancer prevention, palliative care, pain management, and expanding access to healthcare, according to a new report from the American Cancer Society Cancer Action Network (ACS CAN).

The 16th annual report  grades all 50 states in nine areas: increased access to healthcare coverage through Medicaid, funding for cancer screening, passage of palliative care policies, implementation of balanced pain control policies, smoke-free laws, cigarette taxes, funding for tobacco use prevention and cessation, coverage of tobacco cessation treatment through Medicaid, and barring minors from using indoor tanning devices.

California and Massachusetts met the ACS CAN benchmarks in six or more categories, putting those two states on top. Following behind, 30 states and the District of Columbia met benchmarks in three to five of the nine areas, while 18 states reached the goals in two or fewer of the ACS CAN's priority areas.

"By passing the cancer-fighting measures laid out in this report, lawmakers will not only be saving lives today and for years to come, they'll be reducing long-term health care costs that can be reinvested back into state economies," said Chris Hansen, president of ACS CAN, in a statement accompanying the report.  

One of the most important measures is access to care. And expanded access to Medicaid has represented a substantial improvement in how many people can receive healthcare, according to ACS CAN.

The report notes, "Individuals without health insurance are more likely to be diagnosed with cancer at a later stage and more likely to die from the disease."  Seventeen states have not taken advantage of the additional federal funds that would be available to them under the Affordable Care Act to expand Medicaid.

Some states are putting up roadblocks to make Medicaid coverage less accessible by imposing work or other requirements that may be difficult for cancer patients and survivors to meet, according to ACS CAN. 

Kentucky, Indiana, and Arkansas have already received the go-ahead from the federal government to impose work, job training, and/or community engagement requirements, and eight more states are awaiting a decision on their applications.

The ACS CAN report also looked at cancer screening efforts. For instance, the Centers for Disease Control and Prevention (CDC) makes funding available for states to provide screening through the Breast and Cervical Cancer Early Detection Program. ACS CAN believes states should appropriate $1 for every $3 in federal funds received from the CDC program. Twenty states hit that measure, but Hawaii, Kentucky, South Dakota, and Vermont provide no state funding at all.

Smoke-free laws, raising excise taxes that increase the cost of cigarettes, and bans on indoor tanning for minors are some of the other measures examined.

The national average excise tax for cigarettes is $1.75 per pack. The report found that states in the Northeast and on the West Coast had taxes higher than that average. The Southern tier of tobacco-producing states — along with Colorado, Idaho, Missouri, Nebraska, North Dakota, and Wyoming — had taxes that were equal to or below that national average.

Seventeen states and Washington, DC, prohibit juveniles under age 18 years from using indoor tanning devices, the report found.

Inaugural Look at Pain Policies

For the first time this year, the advocacy group measured how well states balanced the need for restricting opioid use with ensuring access to pain medications and alternative forms of pain management for patients with cancer and survivors.

Driven largely by the opioid crisis, the pain management landscape has vastly changed, even in just the last few years, according to ACS CAN. The organization said that in 2015, fewer than 80 state legislative proposals were introduced to address pain management and opioid issues; by 2018, more than 470 such proposals were introduced. Some are erecting barriers that make it harder for patients with cancer and survivors to secure needed medications or pain relief, said ACS CAN.

It documents some of its findings in the overall state report but also created a new report card devoted to pain management and opioid access, rating states on how well they adhere to a model policy developed by ACS CAN.

Four states are doing very well, matching 80% of what the model suggests: New Hampshire, New Mexico, Vermont, and Virginia. Eight states matched up with less than half the suggested important aspects of a model policy: Arkansas, Illinois, Indiana, Maryland, Missouri, Montana, North Dakota, and South Dakota.