Open AccessEvaluation of Patient‐Reported Delays and Affordability‐Related Barriers to Care in Head and Neck Cancer
Author(s) -
Lenze Nicholas R.,
Bensen Jeannette T.,
Farnan Laura,
Sheth Siddharth,
Zevallos Jose P.,
Yarbrough Wendell G.,
Zanation Adam M.
Publication year - 2021
Publication title -
oto open
Language(s) - English
Resource type - Journals
ISSN - 2473-974X
DOI - 10.1177/2473974x211065358
Subject(s) - medicine , cohort , head and neck cancer , medicaid , cancer , head and neck squamous cell carcinoma , quality of life (healthcare) , retrospective cohort study , survivorship curve , health care , cohort study , physical therapy , family medicine , nursing , economics , economic growth
Objective To examine the prevalence and predictors of patient‐reported barriers to care among survivors of head and neck squamous cell carcinoma and the association with health‐related quality of life (HRQOL) outcomes. Study Design Retrospective cohort study. Setting Outpatient oncology clinic at an academic tertiary care center. Methods Data were obtained from the UNC Health Registry/Cancer Survivorship Cohort. Barriers to care included self‐reported delays in care and inability to obtain needed care due to cost. HRQOL was measured with validated questionnaires: general (PROMIS) and cancer specific (FACT‐GP). Results The sample included 202 patients with head and neck squamous cell carcinoma with a mean age of 59.6 years (SD, 10.0). Eighty‐two percent were male and 87% were White. Sixty‐two patients (31%) reported at least 1 barrier to care. Significant predictors of a barrier to care in unadjusted analysis included age ≤60 years ( P =. 007), female sex ( P =. 020), being unmarried ( P =. 016), being uninsured ( P =. 047), and Medicaid insurance ( P =. 022). Patients reporting barriers to care had significantly worse physical and mental HRQOL on the PROMIS questionnaires ( P <. 001 and P =. 002, respectively) and lower cancer‐specific HRQOL on the FACT‐GP questionnaire ( P <. 001), which persisted across physical, social, emotional, and functional domains. There was no difference in 5‐year OS (75.3% vs 84.1%, P =. 177) or 5‐year CSS (81.6% vs 85.4%, P =. 542) in patients with and without barriers to care. Conclusion Delay‐ and affordability‐related barriers are common among survivors of head and neck cancer and appear to be associated with significantly worse HRQOL outcomes. Certain sociodemographic groups appear to be more at risk of patient‐reported barriers to care.