Insurance status and head and neck radiotherapy interruption disparities in the Mid‐Southern United States. Issue 8 (6th March 2020)

• Record Type: Journal Article
• Authors: Yarn, Charles; Wakefield, Daniel V.; Spencer, Sharon; Martin, Michelle Y.; Pisu, Maria; Schwartz, David L.
• Is Part Of: Head & neck. Volume 42:Issue 8(2020)
• Page Start: 2013
• Page End: 2020
• Publication Date: 2020-03-06
• Subjects: cancer disparities -- head and neck cancer -- health insurance -- radiation therapy -- treatment interruption; Head -- Diseases -- Periodicals; Neck -- Diseases -- Periodicals; Head -- Periodicals; Neck -- Periodicals; Face -- Periodicals; 617.51059
• DOI: 10.1002/hed.26128
• Languages: English
• ISSNs: 1043-3074

Abstract

Abstract: Background: Relationships between health insurance coverage and radiotherapy (RT) interruption rates in patients with head and neck (H&N) cancer remain unclear. Methods: We performed a retrospective cohort study at our academic center. Days of RT interruption for individual patients were tabulated, analyzed for explanatory variables, and geographically mapped. Results: 894 of 7526 (11.9%) scheduled treatment days were interrupted, impacting 149 of 216 (69%) patients. Medicaid/uninsured patients experienced a 7.3 day mean interruption (SD = 9.9) vs 3.4 days (SD = 5.2) for Medicare/private patients ( P < .001). RT interruption was predicted by insurance status in multivariate analysis ( P = .008). Higher RT interruption rates overlapped geospatially with low predicted median household income and racial minority neighborhoods. Conclusion: Unplanned treatment interruptions are a key source for H&N RT quality shortfalls in Medicaid/uninsured patients. This is the first geographic benchmarking of H&N RT delivery disparities across a complete metropolitan region, and will guide interventions studies to reduce interruption risk.