Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Program Number: B360
Session Name: Poster Session
Examining Insurance Disparities in Diagnosis-to-Treatment Interval and Cancer Care Parameters among Head and Neck Cancer Survivors
Brandon A Aguilar, BS1; Stephen Glass, BS, MA2; Fendi Obuekwe, BS1; Angela L Mazul, PhD, MPH3; Jessica H Maxwell, MD, MPH3; Jonas T Johnson, MD3; Marci L Nilsen, PhD, MSN, RN3,4; 1University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; 2Department of Biostatistics, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA; 3Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; 4Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USABackground: Early identification and treatment of head and neck cancers (HNC) are essential to improve outcomes, and failure may lead to increased disease progression and mortality. Disparities in outcomes have been demonstrated among insurance types in HNC. Patients with Medicaid insurance are more likely to present with advanced disease and have longer diagnosis-to-treatment intervals (DTI) compared to patients with advanced disease. In this ancillary study, we aim to examine the correlation between DTI and insurance type among HNC survivors, with our analysis focusing on identifying insurance disparities impacting patients with prolonged DTI.
Objective: This study aims to assess the association between insurance type and DTI among HNC survivors.
Methods: This study included patients with biopsy-proven primary head and neck cancer enrolled in the Enhanced Care Coordination (ECC) study from January 2020 to February 2024. Squamous cell carcinoma (SCC) cases with unknown primary locations were included. Those excluded consist of non-malignant tumors, patients who received prior radiation treatment for SCC in specified areas, clinical evidence of distant metastasis, and those who were lost to follow-up.
Demographic and health-related data such as age, sex assigned at birth, gender, race, ethnicity, and marital status were collected from the ECC study. Medical records provided information on staging, treatment dates, and treatment modalities (radiotherapy, chemoradiotherapy, or surgery with adjuvant RT/CRT). Individual chart review identified insurance details, biopsy date, cytology date, and histopathological diagnosis date. Patients were categorized by insurance type, including commercial, Medicare Advantage, Medicare, Medicaid, uninsured, or unknown. The diagnosis-to-treatment interval (DTI) was defined as the number of days between the histopathological diagnosis and the first treatment date. Linear regression was used to investigate the predictors of primary and secondary insurance types on DTI.
Results: A total of 233 patients (mean [SD] age, 64.20 [10.78] years; 73.8% male) met the inclusion criteria. Demographic variables that were controlled include age, sex assigned at birth, relationship status, race, and ethnicity. The average interval from diagnosis to treatment was 40.65 days, with a standard deviation of 35.95 days. The distribution of primary insurance from the working dataset includes commercial insurance (49.4%), Medicare Advantage (29.2%), Medicaid (11.6%), and Medicare (8.2%). Analysis showed that the primary insurance type influenced the diagnosis-to-treatment interval after adjusting for demographic variables (p=0.027). Patients with commercial insurance were more likely to present with shorter diagnosis-to-treatment intervals than those with Medicare Advantage plans (95% confidence interval [CI], 3.33-18.92, p=0.005) while controlling for covariates. The latter group exhibited an increase in the diagnosis-to-treatment interval by an average of 11.13 days.
Conclusions: After adjusting for demographic variables, patients enrolled in Medicare Advantage plans had prolonged diagnosis-to-treatment intervals compared to those with commercial health insurance. This observation highlights the necessity of enhancing the quality of insurance coverage and implementing interventions to increase access to timely treatment in HNC.