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Patients with head and neck cancer ‘uniquely disadvantaged,’ face higher medical expenses
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Patients with head and neck cancer had higher medical expenses than patients with other cancer types, creating a substantial added burden for an already financially strained population, according to results of a retrospective study published in JAMA Otolaryngology – Head & Neck Surgery.
“It is increasingly important for practitioners and the health care system to understand the financial burden on patients and society,” Sean T. Massa, MD, of the department of otolaryngology-head and neck surgery at Washington University School of Medicine in St. Louis, and colleagues wrote. “Individuals with [head and neck cancer] are expected to be particularly vulnerable to the financial strains given the established association with lower socioeconomic status. This study, which used national data from nearly 2 decades, found that patients with [head and neck cancer] in the United States are uniquely disadvantaged compared with patients with other cancer in terms of poverty, educational level and overall health.”
Massa and colleagues obtained data on 16,771 patients (mean age, 62.3 years; 53.7% women) with cancer who participated in the Medical Expenditure Panel Survey between 1997 and 2015. Of those patients, 489 had head and neck cancer.
Results showed that patients with head and neck cancer appeared more likely to be members of a racial/ethnic minority, men, poor, publicly insured, less educated, and have a lower general and mental health status than patients with other cancers.
Patients with head and neck cancer also had higher median annual medical expenses ($8,384 vs. $5,978; difference, $2,406; 95% CI, 795-4,017) and higher out-of-pocket expenses relative to their incomes (3.93% vs. 3.07%; difference, 0.86%; 95% CI, 0.06-1.66).
Median expenses were lower for Asian vs. white patients with head and neck cancer ($5,359 vs. $10,078; difference, $4,719; 95% CI, 1,481-7,956), Midwesterners ($5,656) and Westerners ($8,094) vs. Northwesterners ($10,549), and those with excellent vs. poor health ($6,714 vs. $16,990).
Researchers observed associations between higher median relative out-of-pocket expenses and unemployment (5.13% vs. 2.35% for employed patients), public insurance (5.35% vs. 2.87% for those with private insurance), poverty (13.07% vs. 2.06% for high-income patients) and lower health status (10.2% vs. 1.58% for those in excellent health).
A lack of data on head and neck cancer stages and treatment regimens and use of survivor survey data served as limitations to this study.
“Many gaps remain in our understanding of the financial burden of [head and neck cancers] on individual families and society,” Massa and colleagues wrote. “Further research is needed to assess the indirect financial costs to families and society as a whole. These costs may include rehabilitation, loss of personal and family income, and the inability to obtain future insurance coverage.”
Although caregivers cannot immediately change the factors associated with these disproportionate financial burdens, they can remain alert to those at risk, Daniel G. Deschler, MD, vice chair of academic affairs at Massachusetts Eye and Ear and professor of otolaryngology at Harvard Medical School, wrote in an accompanying editorial.
“Early identification and integration of at-risk patients into existing support programs as well as innovative creation of new systems and care networks to counter such economic burden are crucial,” Deschler wrote. “An innovation as simple as bundling an electrolarynx into the perioperative care kit with which a patient undergoing laryngectomy leaves the operating room can have a significant effect on that individual’s rehabilitation and future care.” – by John DeRosier
Disclosures: The study authors and Deschler report no relevant financial disclosures.
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