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Medicaid coverage associated with poor outcomes in HNSCC
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Patients with squamous cell cancer of the head and neck who relied on Medicaid insurance had a higher rate of treatment delays and were more likely to have locally advanced cancers than patients with private or Medicare insurance, according to research published in Cancer.
“Over the past 50 years, Medicaid has become the nation’s single largest insurance source for low-income, nonelderly individuals,” Arash O. Naghavi, MD, MS, radiation oncology resident at Moffitt Cancer Center, and colleagues wrote. “Although Medicaid provides healthcare insurance to potentially millions of individuals, including an estimated 160,000 patients with cancer, accumulating data indicate that patients with this type of coverage still may experience poorer oncologic outcomes in multiple malignancies, including [head and neck cancer].”
Naghavi and colleagues analyzed data from 1,698 patients with squamous cell carcinoma of the head and neck who underwent treatment between 1998 and 2011. Median follow-up was 35 months. The researchers used Kaplan–Meier and Cox regression multivariate analysis to calculate locoregional control and OS.
Eleven percent of patients had Medicaid, 56% had private insurance and 34% had Medicare or government insurance.
Compared with non-Medicaid recipients, patients on Medicaid were more likely to be younger, have a history of smoking or heavy drinking, have a longer time between diagnosis and treatment, and have higher tumor and lymph node classifications.
At 3 years, Medicaid insurance was associated with decreased locoregional control (69% vs. 82%) and OS (46% vs. 72%). Additionally, waiting more than 45 days between diagnosis and treatment was associated with worse locoregional control (77% vs. 83%; P = .009) and OS (68% vs. 71%; P = .008) at 3 years.
Multivariate analysis showed Medicaid receipt was associated with poorer locoregional control and shorter OS compared with Medicare or government insurance (locoregional control: HR = 0.68; 95% CI, 0.48-0.97; OS: HR = 0.61; 95% CI, 0.46-0.8) and private insurance (locoregional control: HR = 0.54; 95% CI, 0.38-0.76; OS: HR = 0.47; 95% CI, 0.37-0.59).
“The delayed [diagnosis to treatment initiation] time noted among patients with Medicaid insurance is concerning and warrants further investigation,” the researchers wrote. “Further studies are required to identify the specific causes of treatment delays in patients with Medicaid insurance, improve the process, expedite patient care and optimize outcomes in this patient population.” – by Andy Polhamus
Disclosure: The researchers report no relevant financial disclosures.
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