Geographic Variation in the Costs and Outcomes of Treatment for Head and Neck Cancer

Abstract

45 years of age. Relevant demographic, tumor, and survival variables were extracted for analysis. Hospitals were divided into community cancer programs (100-500 annual cancer cases) and comprehensive community or academic/research programs ( 500 annual cancer cases). Cox regression was used to identify predictors of survival. Results: We identified 54,565 OCSCC patients, 7.6% of whom are younger than 45 years of age (nZ3828). Of these patients, 80%were between 35 and 44 years of age. More males were affected (65.7%) than females. Caucasians represented 86.3% of cases, followed by African Americans (9.5%) and patients of “other” races (4.2%). Private insurance (65.6%) was most common, with Medicaid (17.6%), uninsured (11.7%), and Medicare (5.1%) comprising the rest. Overall survival at 2 and 5 years was 76% and 66%, respectively. The oral tongue subsite was most common (55.4%), followed by floor of mouth (FOM; 28.5%), gingiva/retromolar trigone (15.4%), and buccal mucosa (0.7%). An increasing incidence of oral tongue cancers was seen, while FOM cancers showed a decreasing trend over the study period. A minority of cases was treated at low-volume community cancer centers, which saw more stage I-II disease. Uninsured and Medicaid patients had more advanced stage III-IV disease (P<.001), while those with private insurance had more early-stage disease. Further analysis including treatment, insurance, demographics, and survival was performed. cStage I-II patients without private insurance were more likely to receive some form of chemotherapy. Ethnicity, insurance status, income, age group, pathologic stage, and positive surgical margins are significant prognosticators on univariate analysis. In multivariate analysis, high pathologic stage, nonprivate insurance, treatment at a low-volume community center, and positive margins remained predictors of worse survival. Conclusion: In young patients with oral cavity cancers, differences in treatment, presentation, and survival were seen in those with health disparities. In addition to staging and surgical margins, treatment at low-volume community cancer centers and nonprivate insurance status predicted worse survival. Author Disclosure: K. Zhan: None. E.A. Nicolli: None. T. Day: None.