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High rates of postoperative radiotherapy delay in head and neck cancer before and after Medicaid expansion
Author(s) -
Pang John,
Faraji Farhoud,
Risa Erik,
Mell Loren K.,
Houlton Jeffrey J.,
Califano Joseph A.
Publication year - 2021
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/hed.26736
Subject(s) - medicaid , medicine , head and neck cancer , cohort , confidence interval , port (circuit theory) , hazard ratio , head and neck squamous cell carcinoma , radiation therapy , cohort study , surgery , health care , engineering , electrical engineering , economics , economic growth
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.