Treatment Compliance and Insurance Status in Head and Neck Radiation Therapy Patients

Abstract

Poor treatment compliance with head and neck (H&N) radiation therapy leads to poor cancer outcomes. Our prior work has suggested inferior radiation therapy (RT) compliance in Medicaid/uninsured populations in North Texas. Our aim was to confirm if under-/uninsured populations in the mid-south are at higher risk for H&N radiation therapy treatment delays than insured patients. We hypothesize that this may be a potential mechanism contributing to poor cancer control rates in at-risk populations across different geographic U.S. regions. This was a chart review of 217 H&N RT patients treated at UTHSC-West Cancer Center with curative intent from January 2011 through January 2017. Data analysis was performed with JMP Pro 13 and Tableau. A total of 7574 treatment appointments were scheduled. Nine-hundred fourteen (12%) appointments were cancelled, and 675 treatment interruptions were patient-related (i.e. “Cancel,” or “No Show”). Only 67/217 patients finished treatment with no treatment delays. Of the 217, 150 patients had one or more treatment delay. Medicaid/uninsured patients were at significantly higher risk for treatment delays than privately insured (P=.0007) or Medicare patients (P=.0094). Widowed status (P=.005) and chemotherapy administration (P=.02) were also associated with treatment interruption. Geographic mapping confirmed tight correspondence between total number of missed appointments and median income in home ZIP code. We confirm significant correlation between H&N RT treatment delay and health insurance status. Geographic data qualitatively demonstrate how treatment delays track with known financial disparities in the Memphis region. This work sets the stage for prospective identification of patients at high risk for treatment attrition and focused interventional trials.