ABSTRACT
Objectives: Insurance status has been shown to impact survival
outcomes. We sought to determine whether insurance affects the choice of
treatment modality among patients with advanced (T4) oral cavity
squamous cell carcinoma (OCSCC).
Design: Retrospective, population-based cohort study
Setting : The Survival, Epidemiology, and End Results (SEER)
Program database
Participants: The population included all adult (age> 18) patients with advanced (T4a or T4b) OCSCC
diagnosed from 2007 to 2016.
Main outcome measures : The main outcome measure was the odds of
receiving definitive treatment, defined as primary surgical resection.
Insurance status was categorized into uninsured, any Medicaid, and
insured groups. Univariable, multivariable, and subgroup analyses were
performed.
Results: The study population consisted of 2628 patients, of
whom 1915 (72.9%) were insured, 561 (21.3%) had Medicaid, and 152
(5.8%) were uninsured. The multivariable model showed that patients who
were 80 years or older, unmarried, with T4b disease, received treatment
in the pre-Affordable Care Act (ACA) period, and who were on Medicaid or
uninsured were significantly less likely to receive definitive
treatment. Among patients with T4a disease, insured patients were
significantly more likely to receive definitive treatment compared to
those on Medicaid or uninsured (OR=0.69, 95% CI 0.54-0.88,
p<0.0001 [Medicaid vs. Insured]; and OR=0.65, 95% CI
0.43-0.98, p=0.001 [Uninsured vs. Insured]), however these
differences did not persist when considering only those patients treated
following the 2014 expansion of the ACA.
Conclusions: Insurance status is significantly associated with
treatment modality among adults with advanced stage (T4a) OCSCC. These
findings support the premise of expanding insurance coverage in the
United States.