INTRODUCTION
Head and neck cancers (HNCA) account for 4% of all newly diagnosed
cancers each year in the United States.1 Squamous cell
carcinoma of the oral cavity (OCSCC) and oropharynx comprise the
majority of HNCA, with a combined incidence of 3% per
year.2 For OCSCC, surgery is generally understood to
provide superior oncologic outcomes compared to the primary treatment
modalities of radiotherapy and/or chemotherapy. Underscoring this, the
National Comprehensive Cancer Network (NCCN) guidelines recommend
primary surgery as the first-line treatment modality for OCSCC of all
stages (I-IVA), often followed by adjuvant radiation with or without
chemotherapy.3 Non-curative treatment options that do
not include surgery are reserved for cases of unresectable disease
(stage IVB).
Previous studies have shown that for several different cancer
populations in the United States, insurance status impacts cancer stage
at initial presentation, with uninsured or publicly insured (Medicare,
Medicaid) patients presenting with more advanced cancers than privately
insured patients.4-7 Subsequently, cancer patients who
are uninsured have significantly decreased survival outcomes when
compared to patients with private insurance.8 This
disparity is most likely multifactorial; however, it is known that
insurance type is strongly associated with the odds of receiving
definitive treatment with curative intent.9 This
disparity in cancer care and survival is likely even more pronounced for
those with advanced stages of disease. To our knowledge, the association
between insurance status (including Medicaid coverage), and receipt of
definitive treatment has yet to be investigated for patients with OCSCC.
This information is important to help guide public health initiatives
that seek to reform access to cancer care, and to assist those with less
financial means. The 2010 Patient Protection and Affordable Care Act
(ACA) was designed to expand access to healthcare, largely through
Medicaid expansion. It has assisted millions of individuals with incomes
near the national poverty levels to gain health insurance. However, its
impact on extending oncologic care for patients with OCSCC has yet to be
rigorously investigated.