Even after accounting for stage at diagnosis and several other prognostic factors, head and neck cancer patients who are uninsured or covered by Medicaid or Medicare disability (Medicare under age 65) have worse survival than patients with private insurance. These results were published in Cancer.
Head and neck cancers originate in the tissues in or around the mouth, nose, and throat. Risk factors for head and neck cancer include smoking, alcohol consumption, and infection with high-risk types of human papillomavirus (HPV).
Unfortunately, underinsured or uninsured patients are reportedly at risk for impaired access to care, delays in medical treatment, and in some cases, substandard medical care. Previous studies have reported that patients who are uninsured or who receive Medicaid are more likely than other patients to have advanced cancer at the time of diagnosis.
To explore whether head and neck cancer outcomes vary by insurance status, researchers evaluated information from 1,231 patients who were treated at the University of Pittsburgh Medical Center between 1998 and 2007. The patients had been diagnosed with cancer of the oral cavity, pharynx, or larynx.
In addition to insurance status, information was collected about several other factors that could influence prognosis. These factors included age, gender, smoking status, alcohol consumption, tumor site, treatment, and stage at diagnosis.
- As expected, Medicaid and uninsured patients tended to be diagnosed with more advanced cancer than patients with private insurance.
- After accounting for cancer stage and several other prognostic factors, mortality was 50% higher among Medicaid and uninsured patients than among patients with private insurance.
- Patients with Medicare disability (Medicare under age 65) also had an increased risk of death compared with patients with private insurance.
- Mortality among Medicare patients over the age of 65 was not significantly different than among patients with private insurance.
These results suggest that survival with head and neck cancer varies by insurance status. Patients who are uninsured or covered by Medicaid or Medicare disability have a higher risk of death than patients with private insurance, even after accounting for cancer stage and several other prognostic factors.
The researchers note “This may reflect a lack of preventative care in these populations as well as barriers to healthcare that may delay treatment after diagnosis. Further investigation into our current Medicaid and Medicare disability system is warranted to determine exactly where improvements can be made to improve head and neck cancer outcomes for these populations.”
Reference: Kwok J, Langevin SM, Argiris A et al. The impact of health insurance status on the survival of patients with head and neck cancer. Cancer. Early online publication November 20, 2009.
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