Patients With Head and Neck Cancer Face Lifestyle Alterations and Poor Survival

Two studies presented at the ongoing 2016 Multidisciplinary Head and Neck Cancer Symposium, in Scottsdale, Arizona, report on financial hurdles faced by patients diagnosed with head and neck cancer that result in lifestyle modifications, advanced disease, and worse outcomes.

Researchers retrospectively analyzed national data on patients diagnosed with primary squamous cell carcinoma of the oral cavity, pharynx, or larynx between 2007 and 2012, from the National Cancer Institute’s Survival, Epidemiology and End Results (SEER) database. The nearly 54,000 patients included in the study were divided into 3 cohorts, based on their insurance status: non-Medicaid insurance (80.1%), Medicaid (15%), and uninsured (4.9%).

The study observed a significant difference in disease stage at the time of diagnosis, treatment practices, and mortality between uninsured and Medicaid patients versus the insured patients. Specifically, uninsured and Medicaid patients (75.1% and 72.9%, respectively) were more likely to present with Stage III or IV disease compared with insured patients (60.1%). According to the study, the financially distressed patients were also less likely to receive external beam radiation therapy. Overall, the authors observed significantly greater mortality—both all-cause and cause-specific—in the uninsured and Medicaid population, highlighting the greater vulnerability of this population to cancer-related death. The authors reported the odds ratios (OR) for uninsured and Medicaid patients, respectively, as 1.48 and 1.55 for overall mortality and 1.65 and 1.60 for cause-specific mortality, compared with those for patients with insurance.

“These findings suggest that other risk factors and barriers to care, in addition to health insurance coverage, are responsible for survival differences from head and neck cancers,” said Thomas M. Churilla, MD, resident physician in radiation oncology at the Fox Chase Cancer Center and lead author on the study, in a press release.

Another study presented at the meeting evaluated the influence of cost-coping strategies on the lifestyles of patients with locally advanced head and neck cancers (LAHNC). In this single-institution study, researchers gathered monthly surveys from 73 patients with treatment-naïve LAHNC, diagnosed between May 2013 and November 2014. The primary outcomes assessed included the use of several lifestyle-altering financial coping strategies, out-of-pocket costs, loss of productivity, compliance with medication regimen, and healthcare utilization.

Subsequent data analysis found that 69% of LAHNC patients reported 1 or more lifestyle-altering cost-coping strategy—62% reported spending their savings, 42% reported borrowing money, 25% reported selling possessions, and 23% reported longer working hours for family members. Similar to the first study, the patient’s insurance status was a significant determinant of these outcomes. Patients enrolled in Medicaid, the study reported, used more financial coping strategies compared with patients enrolled in private health plans (OR, 42.3; P = .005).

The study’s lead author, Sunny Kung, a medical student at the University of Chicago, believes social interventions can help. “Many of the patients we treat for advanced head and neck cancers may need support beyond their medical care. Social interventions can be introduced for patients who feel isolated in order to minimize financial burden while maximizing effective health care utilization. For example, providers can work with patient navigators to improve adherence to medical care among vulnerable populations,” she said in an associated press release.