Osazuwa-Peters and his co-authors say the while increasing health insurance coverage removes a major barrier to care for many patients, other socio-economic determinants must be considered when evaluating the quality of disease treatment. These may include transportation challenges, poor health literacy, childcare responsibilities, late diagnosis and competing work-place obligations.

"This research will help us understand how expanding insurance coverage affects access to care among patients with head and neck cancer who generally present at late stages and with poor prognoses," the authors wrote.


The authors used the National Cancer Database (NCDB), querying data on adults aged 18-74, diagnosed with a first-time primary head or neck malignant abnormality between 2011-15. The authors evaluated changes in the percentage of uninsured patients from 2011-13 (pre-ACA) to 2014-15 (post-ACA).

The NCDB is a nationwide hospital-based cancer database containing 70% of all newly diagnosed cancers in the United States. It is a result of a collaboration between the Commission on Cancer, the American Cancer Society and the American College of Surgeons.

There were 77,071 patients diagnosed with head and neck cancer between 2011-13 and 54,708 patients diagnosed between 2014-15. The cohort was 80.6% non-Hispanic white, 74.5% male and 55.5% aged between 50-64 years of age. Most - 108,140 or 82.1% - resided in metropolitan areas.

Patients fell relatively evenly across an income spectrum, with 20% considered low income, 24.6% mid-low, 26.5% mid-high and 28.7% considered high income.

Take-aways

Head and neck cancer is among the most expensive cancers to treat
Head and neck cancer patients represent a population that is likely to bear a large financial burden during their illness
Findings show an uptick in insurance coverage among head and neck cancer patients meaning more of them can afford the cost of their care
More patients became insured under the ACA in low-income zip codes, compared with high-income zip codes
Owing to the constraints of the NCDB data set, authors were unable to assess variations in insurance coverage across groups in Medicaid expansion versus non-expansion states. The NCDB insurance definition only reflects a patient's status at the time of diagnosis, and thus cannot be used to track individual patients' insurance status over time.

The authors recommend further studies into the association of ACA with access to evidence-based treatment of head and neck cancers, particularly in vulnerable populations.

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