Health insurance affects head and neck cancer treatment patterns and outcomes

Publication date: Available online 8 January 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Gino Inverso, Brandon A. Mahal, Ayal A. Aizer, R. Bruce Donoff, Sung-Kiang Chuang
PurposeThe purpose of this study is to examine the effect of insurance coverage on stage of presentation, treatment, and survival of head and neck cancer (HNC).Materials and MethodsA retrospective study was conducted utilizing the Surveillance, Epidemiology and End Results (SEER) program to identify patients diagnosed with HNC. The primary variable of interest was insurance analyzed as a dichotomous variable: Subjects were considered uninsured if they were classified as "uninsured" by SEER, while subjects were considered insured if they were defined by SEER as "any Medicaid", "insured", and "insured/no specifics". The outcomes of interest were cancer stage at presentation (M0 versus M1), receipt of definitive treatment, and head and neck cancer-specific mortality (HNCSM). Multivariable logistic regression modeled the association between insurance status and stage at presentation and receipt of definitive treatment, while HNCSM was modeled using Fine and Gray competing-risks. Sensitivity logistic regression analysis was used to determine whether observed interactions remained significant by insurance type (Privately insured, Medicaid, and uninsured).ResultsSubjects without medical insurance were more likely to present with metastatic cancer (Adjusted odds ratio [AOR] 1.60; P<0.001), more likely to not receive definitive treatment (AOR 1.64; P<0.001), and had a higher risk of HNCSM (AHR 1.20; P=0.002). Sensitivity analyses revealed that when stratifying results by insurance type, significant interactions remained for uninsured subjects and subjects with Medicaid.ConclusionUninsured patients and patients with Medicaid are more likely to present with metastatic disease, more likely to not be treated definitively, and are at a higher risk for HNCSM. The observed treatment gap between Medicaid and private insurance seen in the present study should serve as an immediate policy target for healthcare reform.

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