Effect of Hospital Safety Net Burden on Survival for Patients With Sinonasal Squamous Cell Carcinoma

Abstract

Objective To examine factors associated with hospital safety net burden and its impact on survival for patients with sinonasal squamous cell carcinoma (SNSCC). Study Design Retrospective database study. Setting National Cancer Database from 2004 to 2016. Methods SNSCC cases were identified in the National Cancer Database. Hospital safety net burden was defined by percentage of uninsured/Medicaid patients treated, namely ≤25% for low-burden hospitals, 26% to 75% for medium-burden hospitals, and >75% for high-burden hospitals (HBHs). Univariate and multivariate analyses were used to investigate patient demographics, clinical characteristics, and overall survival. Results An overall 6556 SNSCC cases were identified, with 1807 (27.6%) patients treated at low-burden hospitals, 3314 (50.5%) at medium-burden hospitals, and 1435 (21.9%) at HBHs. On multivariate analysis, Black race (odds ratio [OR], 1.39; 95% CI, 1.028-1.868), maxillary sinus primary site (OR, 1.31; 95% CI, 1.036-1.643), treatment at an academic/research program (OR, 20.63; 95% CI, 8.868-47.980), and treatment at a higher-volume facility ( P < .001) resulted in increased odds of being treated at HBHs. Patients with grade III/IV tumor (OR, 0.70; 95% CI, 0.513-0.949), higher income ( P < .05), or treatment modalities other than surgery alone ( P < .05) had lower odds. Survival analysis showed that hospital safety net burden status was not significantly associated with overall survival (log-rank P = .727). Conclusion In patients with SNSCC, certain clinicopathologic factors, including Black race, lower income, treatment at an academic/research program, and treatment at facilities in the West region, were associated with treatment at HBHs. Hospital safety net burden status was not associated with differences in overall survival. Level of evidence 4.

The Impact of Hospital Safety‐Net Burden Status on Patients with HPV‐Positive Oropharyngeal Cancer

“…Consistent with the present findings, higher safety‐net burden status has also been associated with delayed time to treatment, similar or increased hospital LOS, and similar rates of surgical readmissions 9–11,13,14,16,19 . With regards to overall survival, previous studies have conflicted, demonstrating no difference for patients with sinonasal and oral cavity tumors, 11,15 but inferior overall survival for patients with laryngeal tumors treated at HBH 14 . Notably, many of these studies either did not include patients with OPSCC, or pooled all patients with head and neck cancer, which is a heterogenous population 9–16 .…”

“…In the present study, no differences in CDCC score were found between patients treated at HBH, MBH, or LBH. Previous studies have conflicted on the potential association between comorbidities and treating hospital safety‐net burden, with several studies finding that higher burden hospitals were more likely to treat patients with more comorbidities, whereas other studies have found no difference, similar to the present analysis 10,12–15 . Nevertheless, by including CDCC score as one of the covariates in our multivariable‐adjusted analyses, we were able to account for any potential impact from differences in patient comorbidities.…”

“…With regards to overall survival, previous studies have conflicted, demonstrating no difference for patients with sinonasal and oral cavity tumors, 11,15 but inferior overall survival for patients with laryngeal tumors treated at HBH 14 . Notably, many of these studies either did not include patients with OPSCC, or pooled all patients with head and neck cancer, which is a heterogenous population 9–16 . Several studies also evaluated single institution samples and had varied definitions of safety‐net burden 9,12,13,16 .…”

“…Outcomes of patients with human papillomavirus (HPV)‐positive oropharyngeal squamous cell carcinoma (OPSCC) have been shown to vary across both patient social determinants of health, including demographics and socioeconomic status, and facility characteristics 1–5 . Given the importance of insurance status on outcomes at the individual patient level, 1,2,6–8 previous literature has attempted to expand this relationship to the facility level by evaluating a hospital's safety‐net burden status 9–16 . High safety‐net burden hospitals are defined as those that “organize and deliver a significant level of health care and other health‐related services to uninsured, Medicaid, and other vulnerable patients” 17 .…”

Value of peripheral blood ratio in diagnosis and prognosis prediction of sinonasal squamous cell carcinoma Running title: Peripheral blood ratio in SNSCC

“…Early speci c symptoms of the disease are relatively absent given the anatomy of the nasal cavity and paranasal sinuses patients, usually presenting at an advanced stage by the time of diagnosis. There is an urgent need for parameters that can assist in early diagnosis [3]. Furthermore, despite the declining incidence of SNSCC and improvement in the treatment of SNSCC, the 5-year overall survival (OS) rate has not signi cantly improved over the past 50 years and still lingers at 30%-50%, with local recurrence being the leading cause of death [4][5][6][7][8][9].…”