Abstract
Objective: This study aimed to explore the influence of social support on the survival outcomes of patients with nasopharyngeal carcinoma (NPC). We examined whether the combined proxy influenced whether patients were more likely to receive radiotherapy. Methodology: data were collected from the 18 registries of the National Cancer Institute’s Surveillance, Epidemiology, and End Results database. The association between both insurance status and marital status and disease-specific survival rates were evaluated with a multivariate Cox proportional-hazards regression model to calculate the hazard ratios and associated confidence intervals. Odds ratio (OR) computed by logistic regression was also used to examine the relationship between the receipt of radiotherapy and insurance and marital status. Results: insured and uninsured patients differed significantly in T-stage, N-stage, M-stage, radiotherapy use, race, and marital status. The uninsured-non-married patients showed the lowest 5-year disease-specific survival rates. We further found unmarried patients with either Medicaid (OR, 0.40), or no insurance (OR, 0.24) had lower odds of receiving radiotherapy than those with insurance at diagnosis. Conclusions: uninsured-unmarried NPC patients had a significantly higher risk of distant metastasis at diagnosis, poorer 5-year disease-specific survival, and were less likely to receive radiotherapy than insured-married patients.
Highlights
A recent study using the National Cancer Institute (NCI) Surveillance, Epidemiology, and End
We identified patients with nasopharyngeal carcinoma (NPC) diagnosed in the 18 registries of the SEER database, which is sponsored by the NCI and covers 34.6% of the US population
The highest proportion of early T-stage were among the insured patients compared to those on Medicaid or uninsured
Summary
We identified patients with NPC (the 3rd edition of the International Classification of Diseases for Oncology [ICD-O-3] codes) diagnosed in the 18 registries of the SEER database, which is sponsored by the NCI and covers 34.6% of the US population. The SEER database provides accurate, timely, and continuous data on patient demographics, clinicopathologic details, and cancer survival. The patients were pathologically diagnosed with primary NPC between January 1, 2007, and December 31, 2013, based on the SEER*Stat software, version 8.3.4. Excluded were 1300 patients who did not meet the study criteria, being one of the following: age at diagnosis ≤18 years or unknown; insufficient or unknown stage, histology and treatment; or lacking clear records on marital status and insurance status
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