Disparities in head and neck cancer: Assessing delay in treatment initiation

Patel, Urjeet A.; Brennan, Tara E.

doi:10.1002/lary.23357

Cited by 52 publications

(50 citation statements)

References 9 publications

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“…Regardless, the trend toward late presentation for patients with low socioeconomic status has been extensively demonstrated . Moreover, stage at presentation is a key predictor of survival for head and neck cancer patients …”

Section: Discussionmentioning

confidence: 99%

Insurance status as a predictor of mortality in patients undergoing head and neck cancer surgery

et al. 2017

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Objective Explore relationship between insurance status and survival, determine outcomes that vary based on insurance status, and identify potential areas of intervention. Study Design Retrospective cohort analysis of patients who underwent resection of an upper aerodigestive tract malignancy at a single tertiary care hospital during a 5-year period. Methods Patients were categorized into four groups by insurance status: Medicaid or uninsured, Medicare and under 65 years of age, Medicare and 65 years or older, and private insurance. Data were collected from the medical record and analyzed with respect to survival and other outcomes. Results The final cohort consisted of 860 patients. Survival analysis demonstrated a hazard ratio of 2.1 (95% confidence interval [CI], 1.5–3.0) for the Medicaid/uninsured group when compared to the private insurance group. When adjusted for other variables, mortality was still different across insurance groups (P = 0.002). The following also were different across insurance groups: tumor stage (P < 0.001), American Society of Anesthesiologists score (P < 0.001), length of stay (P < 0.001), and complications (P = 0.021). The Medicaid/uninsured group was most likely to have a complication (odds ratio [OR] = 2.10, 95% CI 1.24–3.56, P = 0.006). Conclusion Medicaid/uninsured patients present with more advanced tumors and have poorer survival than privately insured patients. Insurance status is predictive of tumor stage, comorbidity burden, length of stay, and complications. Specifically, the Medicaid/uninsured group had high rates of tobacco use and alcohol abuse, advanced stage tumors, and postoperative complications. Because alcohol abuse and advanced stage also were predictors of poor survival, they may contribute to the survival disparity for socially disadvantaged patients.

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Section: Discussionmentioning

confidence: 99%

Insurance status as a predictor of mortality in patients undergoing head and neck cancer surgery

et al. 2017

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“…More complete data on HPV status are currently being incorporated and will be considered in future studies . Finally, we were unable to control for travel distance to the closest cancer center in our analysis, even though this may be a better metric to evaluate specific challenges related to costs and delays in access that could stem from living rurally . These limitations, however, must be weighed against the study's many strength, including its large size, population‐based sample, and timespan of greater than 10 years.…”

Section: Discussionmentioning

confidence: 99%

Urban and rural differences in outcomes of head and neck cancer

et al. 2017

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“…Literacy rates can be used as a surrogate to assess the socio-economic condition of our population. Patel et al, (2012) have shown that the median lag of time form the date of first diagnosis to SOT was 48 days and it was prolonged for patients receiving primary radiotherapy compared to surgical therapy. However, in our analysis the MT for SOT for primary surgery was prolonged compared to primary RT.…”

Section: Figure 1 It Shows the Proportion Of Stages At Diagnosis In mentioning

confidence: 99%

Educational Levels and Delays in Start of Treatment for Head and Neck Cancers in North-East India

Krishnatreya¹,

Kataki²,

Sharma³

et al. 2015

Asian Pacific Journal of Cancer Prevention

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Background: There are various patient and professional factors responsible for the delay in start of treatment (SOT) for head and neck cancers (HNC). Materials and Methods: This retrospective study was conducted on data for HNC patients registered at the hospital cancer registry in North-East India. All cases diagnosed during the period of January 2010 to December 2012 were considered for the present analysis. Educational levels of all patients were clustered into 3 groups; illiterates (unable to read or write), qualified (school or high school level education), and highly qualified (college and above). Results: In the present analysis 1066 (34.6%) patients were illiterates, 1,869 (60.6%) patients were literates and 145 (4.7%) of all patients with HNC were highly qualified. The stage at diagnosis were stage I, seen in 62 (34.6%), stage II in 393 (12.8%), stage III in 1,371 (44.5%) and stage IV in 1,254 (40.7%) . The median time (MT) to the SOT from date of attending cancer hospital (DOACH) was, in illiterate group MT was 18 days, whereas in the qualified group of patients it was 15 days and in the highly qualified group was 10 days. Analysis of variance showed there was a significant difference on the mean time for the delay in SOT from DOACH for different educational levels (F=9.923, p=0.000). Conclusions: Educational level is a patient related factor in the delays for the SOT in HNCs in our population.

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Disparities in head and neck cancer: Assessing delay in treatment initiation

Cited by 52 publications

References 9 publications

Insurance status as a predictor of mortality in patients undergoing head and neck cancer surgery

Insurance status as a predictor of mortality in patients undergoing head and neck cancer surgery

Urban and rural differences in outcomes of head and neck cancer

Educational Levels and Delays in Start of Treatment for Head and Neck Cancers in North-East India

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