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2016 Head and Neck Cancer Symposium: Uninsured and Medicaid Patients More Likely to Present With Advanced Tumors, Experience Cancer-Specific Mortality

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Key Points

  • Uninsured and Medicaid patients, compared to insured patients, were more likely to present with advanced disease, such as larger tumors or more extensive lymph node involvement; were less likely to receive radiation therapy; and had higher mortality rates following cancer.
  • Rates of both overall mortality and cause-specific mortality were higher for uninsured and Medicaid patients, indicating that this subset of head and neck cancer patients is particularly vulnerable to cancer-related death.

Compared to patients with non-Medicaid insurance, uninsured patients and patients with Medicaid are more likely to present with advanced stages of head and neck cancer and have higher overall and cancer-specific mortality rates, according to research presented by Churilla et al at the 2016 Multidisciplinary Head and Neck Cancer Symposium (Abstract 12). The study of patients in a large, national cancer registry also found less use of radiation therapy for uninsured and Medicaid patients and less use of cancer-related surgery for uninsured patients.

Drawing on the National Cancer Institute’s Survival, Epidemiology and End Results (SEER) database, researchers examined clinical, demographic, and socioeconomic variables in the records of all 53,848 patients diagnosed with primary squamous cell carcinoma of the oral cavity, pharynx, or larynx between 2007 and 2012. Patients were divided into three cohorts based on health insurance status: patients with non-Medicaid insurance (80.1%); patients with Medicaid (15%); and patients who were uninsured (4.9%).

Analysis Findings

Head and neck cancer patients with and without insurance differed significantly from each other in terms of disease stage at time of diagnosis, treatment practices, and survival rates. Uninsured and Medicaid patients, compared to insured patients, were more likely to present with advanced disease, such as larger tumors or more extensive lymph node involvement; were less likely to receive radiation therapy; and had higher mortality rates following cancer.

Specifically, uninsured patients and Medicaid patients, compared to insured patients, were more likely to present with American Joint Committee on Cancer stage III or IV disease (75.1% uninsured, 72.9% Medicaid, 60.1% insured; P < .001). These patients also were less likely to receive external beam radiation therapy (odds ratio [OR] for uninsured = 0.68; OR for Medicaid = 0.77; both P < .05), and uninsured patients were less likely to receive cancer-directed surgery (OR = 0.86; P < .05).

Perhaps most alarmingly, rates of both overall mortality and cause-specific mortality were higher for uninsured and Medicaid patients, indicating that this subset of head and neck cancer patients is particularly vulnerable to cancer-related death. Odds ratios for uninsured and Medicaid patients, respectively, were 1.48 and 1.55 for overall mortality and 1.65 and 1.60 for cause-specific mortality, compared to those for patients with insurance.

“We were surprised by the similarity in outcomes among the uninsured patients and Medicaid patients,” said Thomas M. Churilla, MD, a resident physician in radiation oncology at Fox Chase Cancer Center. “These findings suggest that other risk factors and barriers to care, in addition to health insurance coverage, are responsible for survival differences from head and neck cancers.”

“Access to cancer care is a complex topic, and further study is necessary to determine what mix of patient, provider, and disease-related factors are responsible for this disparity in mortality rates. Based on our study, expansions in Medicaid may not significantly affect outcomes for head and neck cancer patients unless we also explore and address these other underlying factors,” concluded Dr. Churilla.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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