Medicaid, uninsured patients experience worse head and neck cancer outcomes

Uninsured patients and those with Medicaid appeared more likely to present with advanced stages of head and neck cancers and to have inferior outcomes than those who have other forms of insurance, according to study results presented at the Multidisciplinary Head and Neck Cancer Symposium.

Further, radiation and cancer-related surgery occurred less frequently among patients who are uninsured or have Medicaid.

Thomas M. Churilla, MD

Thomas M. Churilla, MD, resident physician in radiation oncology at the Fox Chase Cancer Center in Philadelphia, and colleagues used the SEER database to evaluate the impact of health insurance status on treatment and outcomes among patients with head and neck cancer.

The analysis included data from 53,848 patients with head and neck cancer of the oral cavity, pharynx or larynx who were diagnosed between 2007 and 2012.

In that cohort, 80.1% of the patients were insured, 15% had Medicaid and 4.9% were uninsured.

Stage III to stage IV disease at time of diagnosis appeared more common among uninsured patients (75%) and those with Medicaid (72.9%) than in insured patients (60.1%; P < .001).

After multivariable adjustments, uninsured patients appeared less likely to receive cancer-related surgery (OR = 0.86; 95% CI, 0.77-0.97) than insured patients. Further, external beam radiation therapy occurred less frequently among uninsured patients (OR = 0.68; 95% CI, 0.62-0.75) and patients with Medicaid (OR = 0.77; 95% CI, 0.72-0.81).

The researchers also found patients with Medicaid or uninsured had worse survival outcomes than the insured population.

After adjusting for surgery, radiation therapy, tumor and demographic characteristics, Medicaid patients demonstrated an increased risk for overall mortality (1.55; 95% CI, 1.49-1.62) and cause-specific mortality (1.6; 95% CI, 1.55-1.69) compared with insured patients.

When compared with insured patients, uninsured patients also demonstrated an increased risk for overall mortality (1.48; 95% CI, 1.38-1.58) and cause-specific mortality (1.65; 95% CI, 1.52-1.79).

“We hypothesize that lack of access to primary care and dental providers may be one of the reasons why more patients are presenting with locally advanced disease,” Churilla said during a press briefing. “[Also], the similarity between Medicaid and uninsured cancer specific survival is concerning.

“We need further study to determine which patient, provider and health care system factors may be contributing to the differences,” he added. – by Anthony SanFilippo

Reference:

Churilla TM, et al. Abstract 7. Presented at: Multidisciplinary Head and Neck Cancer Symposium; Feb. 18-19, 2016; Scottsdale, Ariz.

Disclosure: The researchers report no relevant financial disclosures.