Oral cancer patients achieve comparable survival at high safety-net burden hospitals

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

“…Consistent with the present findings, higher safetynet burden status has also been associated with delayed time to treatment, similar or increased hospital LOS, and similar rates of surgical readmissions. [9][10][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.…”

“…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 .…”

“…Given the above considerations, we speculate that there may be intrinsic factors of higher safety‐net burden facilities that contribute to the differences in treatment patterns and outcomes seen in the present study. For example, the greater demand placed on the few highly specialized surgeons to perform the complex procedures required to treat OPSCC at higher burden facilities, as well as more advanced tumor presentations, 11,14 may contribute to the increased use of radiation over surgery. In addition, the need for advanced equipment and unique skillset required to perform TORS may lead to its less frequent use 23 .…”

“…Treatment facilities included in this study were evaluated for safety-net burden (i.e., the proportion of uninsured or Medicaid-insured patients treated at the facility) based on previously described methods. 11,14,15 Safety-net burden was defined as the average number of uninsured and Medicaid-insured patients treated for OPSCC per year. Facility volume was defined as the average number of patients with OPSCC treated per year.…”

“…[1][2][3][4][5] Given the importance of insurance status on outcomes at the individual patient level, 1,2,[6][7][8] previous literature has attempted to expand this relationship to the facility level by evaluating a hospital's safety-net burden status. [9][10][11][12][13][14][15][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 In addition to treating more patients with low socioeconomic status, high safety-net burden hospitals have been shown to treat more patients with advanced stage head and neck cancer and have been associated with increased time to treatment, more urgent or emergent admissions, longer hospital length of stay (LOS), decreased follow-up, and lower overall survival compared to lower safety-net burden hospitals.…”