Nationwide Utilization of Cardiac Imaging in Patients Undergoing External Beam Radiation Therapy With and Without Cardiotoxic Chemotherapy

Abstract

nasopharynx (1,762). Patients were stratified by their insurance status, including uninsured or Medicaid, and non-Medicaid (insured or insured/no specifics). Covariates include age, gender, race, marital status, percent of county below 150% federal poverty level, TNM stage, and receipt of cancer directed surgery and/or radiation therapy. A Cox proportional hazards regression was used to estimate the effect of insurance status on cancer stage, radiation treatment received, and cause-specific survival. Results: The proportion of Medicaid or uninsured patients was approximately 25% in oral cavity, oropharynx, and nasopharynx, 33% in larynx, and 36% in hypopharynx. Overall, patients were more likely to have localized diseased (T1-2N0) if they had non-Medicaid insurance, rather than Medicaid or uninsured. The Odds Ratio (OR) for localized disease was 2.7 in larynx (53% vs 29%) and oropharynx (11% vs 6%), and was 1.2 in the other sites (p < 0.001 for all sites). Similarly, patients were more likely to receive radiation therapy with non-Medicaid insurance, with OR ranging from 2.9 in oral cavity to 1.7 in larynx (p < 0.001 for all sites). After adjustment for all factors, patients were more likely to die of their cancer if they had Medicaid or were uninsured. The Hazard Ratio (HR) ranged from approximately 2.0 in oral cavity, oropharynx, and nasopharynx to 1.4 in larynx (p < 0.001 for all sites).