BACKGROUND: Although patients who have early-stage oropharyngeal cancer can be treated with little impairment of function, the treatment of advanced disease can result in decreased quality of life and mortality. Patients without insurance and with other barriers to access to care may delay seeking medical attention for early symptoms, resulting in more advanced disease at presentation. In this study, the authors examined whether patients who had no insurance or who were covered by Medicaid insurance were more likely to present with advanced oropharyngeal cancer. METHODS: In this retrospective cohort study from the National Cancer Database from 1996 to 2003, patients with known insurance status who were diagnosed with invasive oropharyngeal cancer at Commission on Cancer facilities (n = 40,487) were included. Adjusted and unadjusted logistic regression models were used to analyze the likelihood of presenting with more advanced stage disease. RESULTS: After controlling for other sociodemographic characteristics, patients with advanced oropharyngeal cancer at diagnosis were more likely to be uninsured (odds ratio [OR], 1.37; 95% confidence interval [95% CI], 1.21-1.25) or covered by Medicaid (OR, 1.31; 95% CI, 1.19-1.46) compared with patients who had private insurance. Similarly, patients were most likely to present with the largest tumors (T4 disease) if they were uninsured (OR, 2.82; 95% CI, 2.46-3.23) or covered by Medicaid (OR, 2.95; 95% CI, 2.63-3.31). They also were more likely to present with the greatest degree of lymph node involvement (N3) if they were uninsured (OR, 2.06; 95% CI, 1.76-2.40) or covered by Medicaid (OR, 1.66; 95% CI, 1.45-1.90). CONCLUSIONS: Individuals who lacked insurance or had Medicaid coverage were at the greatest risk for presenting with advanced oropharyngeal cancer. In the current study, the results for the Medicaid group may have been influenced by the postdiagnostic enrollment of uninsured patients. Insurance coverage appeared to be a highly modifiable predictor of cancer stage. The findings indicated that it is important to consider the impact of insurance coverage on disease stage at diagnosis and associated morbidity, mortality, and quality of life.
BACKGROUND: Although patients who have early-stage oropharyngeal cancer can be treated with little impairment of function, the treatment of advanced disease can result in decreased quality of life and mortality. Patients without insurance and with other barriers to access to care may delay seeking medical attention for early symptoms, resulting in more advanced disease at presentation. In this study, the authors examined whether patients who had no insurance or who were covered by Medicaid insurance were more likely to present with advanced oropharyngeal cancer. METHODS: In this retrospective cohort study from the National Cancer Database from 1996 to 2003, patients with known insurance status who were diagnosed with invasive oropharyngeal cancer at Commission on Cancer facilities (n = 40,487) were included. Adjusted and unadjusted logistic regression models were used to analyze the likelihood of presenting with more advanced stage disease. RESULTS: After controlling for other sociodemographic characteristics, patients with advanced oropharyngeal cancer at diagnosis were more likely to be uninsured (odds ratio [OR], 1.37; 95% confidence interval [95% CI], 1.21-1.25) or covered by Medicaid (OR, 1.31; 95% CI, 1.19-1.46) compared with patients who had private insurance. Similarly, patients were most likely to present with the largest tumors (T4 disease) if they were uninsured (OR, 2.82; 95% CI, 2.46-3.23) or covered by Medicaid (OR, 2.95; 95% CI, 2.63-3.31). They also were more likely to present with the greatest degree of lymph node involvement (N3) if they were uninsured (OR, 2.06; 95% CI, 1.76-2.40) or covered by Medicaid (OR, 1.66; 95% CI, 1.45-1.90). CONCLUSIONS: Individuals who lacked insurance or had Medicaid coverage were at the greatest risk for presenting with advanced oropharyngeal cancer. In the current study, the results for the Medicaid group may have been influenced by the postdiagnostic enrollment of uninsured patients. Insurance coverage appeared to be a highly modifiable predictor of cancer stage. The findings indicated that it is important to consider the impact of insurance coverage on disease stage at diagnosis and associated morbidity, mortality, and quality of life.
Authors: Michael T Halpern; Melissa A Romaire; Susan G Haber; Florence K Tangka; Susan A Sabatino; David H Howard Journal: Cancer Date: 2014-08-25 Impact factor: 6.860
Authors: Hyunsoon Cho; Angela B Mariotto; Bhupinder S Mann; Carrie N Klabunde; Eric J Feuer Journal: Am J Epidemiol Date: 2013-07-03 Impact factor: 4.897
Authors: Ya-Chen Tina Shih; Patricia A Ganz; Denise Aberle; Amy Abernethy; Justin Bekelman; Otis Brawley; James S Goodwin; Jim C Hu; Deborah Schrag; Jennifer S Temel; Lowell Schnipper Journal: J Clin Oncol Date: 2013-10-14 Impact factor: 44.544
Authors: Douglas E Morse; Carmen M Vélez Vega; Walter J Psoter; Himilce Vélez; Carmen J Buxó; Linda S Baek; Augusto Elias; Melba Sánchez Ayendez Journal: BMC Public Health Date: 2011-05-26 Impact factor: 3.295
Authors: Gary V Walker; Stephen R Grant; B Ashleigh Guadagnolo; Karen E Hoffman; Benjamin D Smith; Matthew Koshy; Pamela K Allen; Usama Mahmood Journal: J Clin Oncol Date: 2014-08-04 Impact factor: 44.544
Authors: Joseph Kwok; Scott M Langevin; Athanassios Argiris; Jennifer R Grandis; William E Gooding; Emanuela Taioli Journal: Cancer Date: 2010-01-15 Impact factor: 6.860
Authors: Scott M Langevin; Dominique S Michaud; Melissa Eliot; Edward S Peters; Michael D McClean; Karl T Kelsey Journal: Cancer Causes Control Date: 2012-09-08 Impact factor: 2.506
Authors: Dong Wook Shin; Kee-Taig Jung; Sung Kim; Jae-Moon Bae; Young-Woo Kim; Keun Won Ryu; Jun Ho Lee; Jae-Hyung Noh; Tae-Sung Sohn; Young Ho Yun Journal: BMC Health Serv Res Date: 2009-07-31 Impact factor: 2.655