Association of Tumor Characteristics With Insurance Type Among Patients Undergoing Mohs Micrographic Surgery for Nonmelanoma Skin Cancer

Clarke, Emily L.; Willenbrink, Tyler J.; Shelton, Megan; Naeem, Aneeqah; Custer, James; Lundgren, Ashley D.; Boothe, William D.; Rathouz, Paul J.; Adamson, Adewole S.; Fox, Matthew C.; Jambusaria‐Pahlajani, Anokhi

doi:10.1001/jamadermatol.2022.1802

Cited by 4 publications

(2 citation statements)

References 14 publications

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“…29 These findings are consistent with a recently-published study by Clarke et al, which demonstrated that underinsured patients with NMSC undergoing MMS had significantly larger preoperative tumor bed sizes compared to privately insured patients. 30 Additionally, in lung and colorectal cancer, it has been demonstrated that patients who live farther from a cancer center are more likely to present with more advanced disease. 31 Ultimately, more advanced disease likely reflects both tumor aggressiveness and potential delay in seeking or receiving care, possibly due to provider availability or financial constraints.…”

Section: Discussionmentioning

confidence: 99%

Insurance Status is Associated With Recurrence in Cutaneous Head and Neck Squamous Cell Carcinoma

Victor,

Zheng,

Park

et al. 2023

Otolaryngol.--head neck surg.

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ObjectiveTo identify socioeconomic factors influencing the presentation and outcomes of cutaneous head and neck squamous cell carcinoma (cHNSCC).Study DesignRetrospective cohort study.SettingTertiary academic medical center with comprehensive cancer center.MethodsPatients treated for cHNSCC at a single institution between 2008 and 2022 were included. Demographic, socioeconomic data and disease characteristics were obtained from medical record abstraction. Outcome measures included tumor stage, number of distinct primaries, recurrence, and disease‐related death. χ2 and Mann‐Whitney tests were implemented to evaluate clinicopathologic distributions across disease stages. Survival analyses were performed using Cox regression and Kaplan‐Meier analysis.ResultsA total of 346 patients met the inclusion criteria. The median age at presentation and length of follow‐up was 70.8 and 3.1 years, respectively. The majority of the cohort was white, male, and English‐speaking. 13.3% of patients were underinsured and 27.5% were immunosuppressed. Patients who presented with advanced disease were more likely to be underinsured (21.7% vs 9.6%, P = .006) and have a history of homelessness (8.5% vs 2.1%, P = .014). Immunosuppressed patients were more likely to be underinsured (P = .009). Insurance status (1.97 [1.06‐3.66], P = .032) and immune status (2.35 [1.30‐4.26], P = .005) were independently associated with worse recurrence‐free survival.ConclusionSocioeconomic factors that influence access to care, such as insurance status, are associated with cHNSCC disease stage and disease recurrence. These factors may impose barriers that delay diagnosis and treatment. This may result in worse disease‐related outcomes and greater treatment‐associated morbidity for certain patients.

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Section: Discussionmentioning

confidence: 99%

Insurance Status is Associated With Recurrence in Cutaneous Head and Neck Squamous Cell Carcinoma

Victor,

Zheng,

Park

et al. 2023

Otolaryngol.--head neck surg.

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“…Skin cancer remains the most common cancer in the United States 1,2 . For nonmelanoma skin cancer, which constitutes most skin cancers, Mohs micrographic surgery (MMS) can be performed by fellowship-trained dermatologists to remove tumor cells with intraoperative, microscopic confirmation of clearance 3 . The characteristics such as the size and depth of the defect created after MMS are difficult to predict and may require complex reconstruction, especially in cosmetically and functionally sensitive areas 4 .…”

mentioning

confidence: 99%

Effect of a Perioperative Educational Video in Patients Undergoing Mohs Reconstruction

Das,

Kalmar,

McLawhorn

et al. 2023

Ann Plast Surg

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Background Skin cancer is the most common type of cancer in the United States, and most are treated with Mohs micrographic surgery (MMS) by fellowship-trained dermatologic surgeons. Complex reconstruction in cosmetically and functionally sensitive areas often requires a plastic surgery consult. The uncertainty regarding reconstructive options and cosmetic appearance is difficult emotionally and cognitively for patients. Objectives To improve patient understanding about MMS reconstruction with plastic surgeons, we investigated the utility of a multimedia presentation during perioperative education. Methods A randomized clinical trial was conducted at a hospital-affiliated outpatient MMS clinic and surgery center in the United States. Patients in the intervention arm were given a tablet or Web site link to watch a multimedia presentation about reconstruction after MMS. All patients were given a questionnaire about their understanding of MMS reconstruction and satisfaction with the reconstructive care they received. Results A total of 46 patients were recruited for the study and completed the questionnaire. Of these patients, 22 were randomized to the test intervention arm, and the remaining 24 were in the control group. Among participants in the test intervention arm, feedback regarding the platform was positive with more than 90% of patients reporting that the video was engaging, useful, and easy to understand. Patient understanding and satisfaction scores in the test intervention arm ranked higher across all domains than those of the control group. Conclusions This randomized clinical trial showed increases in patient understanding and satisfaction among patients undergoing MMS reconstruction with the implementation of a perioperative educational video.

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National utilization and reimbursement patterns for Mohs micrographic surgery in the ambulatory surgery setting

Das

McLawhorn

Clayton

et al. 2023

Journal of Plastic, Reconstructive & Aesthetic Surgery

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Association of Tumor Characteristics With Insurance Type Among Patients Undergoing Mohs Micrographic Surgery for Nonmelanoma Skin Cancer

Cited by 4 publications

References 14 publications

Insurance Status is Associated With Recurrence in Cutaneous Head and Neck Squamous Cell Carcinoma

Insurance Status is Associated With Recurrence in Cutaneous Head and Neck Squamous Cell Carcinoma

Effect of a Perioperative Educational Video in Patients Undergoing Mohs Reconstruction

National utilization and reimbursement patterns for Mohs micrographic surgery in the ambulatory surgery setting

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