Head and Neck Squamous Cell Carcinoma in Adolescents and Young Adults: Survivorship Patterns and Disparities

Abstract

Health insurance status is the main nonclinical factor associated with survival among AYAs with HNC, and individuals with Medicaid do not fare better than the uninsured. With a potential longer term follow-up in this AYA population, there is need to optimize survivorship irrespective of health insurance status.

Adolescent and young adult oncology—past, present, and future

“…These changes reduced the number of uninsured AYA patients by 50% in the first 4 years of the ACA, with the dependent care expansion significantly increasing private insurance coverage among those aged 19 to 25 years and the Medicaid expansion increasing public insurance coverage for all young adults . This coverage, however, has not extended equally to all socioeconomic and racial groups, especially AYA patients with low socioeconomic status (SES) or who are black and/or Hispanic and are less likely to have insurance coverage even after the ACA, especially in states that did not expand Medicaid eligibility …”

“…In addition to being underinsured or uninsured, other socioeconomic concerns are a universal consideration for AYA patients, although specific concerns differ based on their age and the presence of dependents . There is evidence supporting a relationship between poverty and decreased access to health care, poorer health care utilization, and inferior patient outcomes in multiple medical conditions, including cancer . An association between neighborhood SES and survival has been demonstrated in AYAs with leukemia, lymphoma, melanoma, breast cancer, and colon cancer .…”

“…Since the implementation of the ACA starting in 2010, there is evidence that the dependent coverage expansion, marketplace insurance, insurance subsidies, and Medicaid expansions have improved insurance coverage and access to care for AYA patients . However, many AYA patients continue to be uninsured or underinsured, and research supports that these individuals may have worse outcomes . The addition of health insurance alone does not address all socioeconomic concerns that AYA patients face, and future efforts should focus not only on identifying disparities but also on interventions to help improve care for all patients.…”

“…43,47,48 This coverage, however, has not extended equally to all socioeconomic and racial groups, es pecially AYA patients with low socioeconomic status (SES) or who are black and/or Hispanic and are less likely to have insurance coverage even after the ACA, especially in states that did not expand Medicaid eligibility. 6,49,50 In addition to being underinsured or uninsured, other so cioeconomic concerns are a universal consideration for AYA patients, although specific concerns differ based on their age and the presence of dependents. 51 There is evidence sup porting a relationship between poverty and decreased access to health care, poorer health care utilization, and inferior patient outcomes in multiple medical conditions, including cancer.…”

Adolescent and young adult cancer survivorship: The new frontier for investigation

“…Finally, the AYA population has a relatively low rate of health care utilization and is less likely to maintain primary care provider connections to maintain wellness . These features of the AYA patient are further compounded by the challenges of sustaining health insurance coverage, depending on their ability to maintain employment, and may impede their access to necessary services . How these unique features of the AYA population relate to the observed increased mortality that Anderson and her colleagues observed is unclear, but further investigation is needed to help health care providers develop interventions that will improve overall survival for these patients.…”