High rates of postoperative radiotherapy delay in head and neck cancer before and after Medicaid expansion

Abstract

Background The objective is to study the effect of Medicaid expansion on postoperative radiation therapy (PORT) delay in patients with head and neck squamous cell carcinoma (HNSCC). Methods Patients from the National Cancer Database with HNSCC undergoing curative‐intent surgery in the 2 years before and after Medicaid expansion were analyzed (n = 11 717) using the difference‐in‐differences technique to study the effect on PORT delay. Results The rate of PORT delay before and after expansion was 66.0% and 66.9%, respectively. Medicaid patients had more frequent PORT delay than privately insured patients (pre‐expansion 77.2% vs. 59.4%, p < 0.001; post‐expansion 76.5% vs. 60.9%, p < 0.001). Medicaid expansion had no effect on PORT delay [hazard ratio 0.95, 95% confidence interval 0.81–1.12]. Supplemental analyses revealed that pathologic stage, number of treating facilities, and comorbidities were among several factors associated with PORT delay in the cohort. Conclusion PORT delay is unacceptably frequent. Improvement in timely adjuvant therapy requires more than Medicaid expansion.

Delays Starting Postoperative Radiotherapy Among Head and Neck Cancer Patients: A Systematic Review and Meta‐analysis

“…For the studies that described an intervention to reduce PORT delay, only data from the preintervention cohort were included in the meta‐analysis. Of the 25 studies that reported frequency of PORT delay defined at >6 weeks, the following were excluded from meta‐analysis: 10 were excluded to minimize duplication of patients included in the NCDB, 6,7,17,33‐39 and 1 was excluded for including a heterogeneous patient population and providing insufficient details about PORT 40 …”

“…Of the 25 studies that reported frequency of PORT delay defined at >6 weeks, the following were excluded from meta-analysis: 10 were excluded to minimize duplication of patients included in the NCDB, 6,7,17,[33][34][35][36][37][38][39] and 1 was excluded for including a heterogeneous patient population and providing insufficient details about PORT. 40…”

Targets for improving disparate head and neck cancer outcomes in the low‐income population

“…Medicaid patients were found to have more frequent delay of postoperative radiation than private insurance patients both before and after Medicaid expansion with no appreciable change with expansion (77% vs. 60% rate of delayed radiation in Medicaid vs. private, respectively). 79 The authors' main conclusion was that Medicaid expansion alone did not decrease radiation delay.…”

“… 78 Unfortunately, over 60% of head and neck patients undergoing curative intent surgery do not receive their radiation within 6 weeks. 55 , 79 …”