Head and Neck
Education and insurance status: Impact on treatment and survival of sinonasal cancer patients
Pratima Agarwal BA Eric A. Jones MS Anand K. Devaiah MD
First published: 04 June 2019 https://doi.org/10.1002/lary.28097
Editor's Note: This Manuscript was accepted for publication on May 16, 2019.
Presented at the Triological Society Annual Meeting at COSM, Austin, Texas, U.S.A., May 3–4, 2019.
p.a. contributed to this work through study conception and design, data extraction, data analysis, data interpretation, and manuscript draft and edits. e.a.j. contributed to this work through data analysis and manuscript revision. a.k.d. contributed to this work through study conception and design, data interpretation, manuscript drafting and edits, and final manuscript approval.
The authors have no funding, financial relationships, or conflicts of interest to disclose.
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Abstract
Objectives/Hypothesis
To understand the impact of education and insurance as social determinants of health on sinonasal cancer treatment and outcomes.
Study Design
Retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER) database.
Methods
Demographics, tumor characteristics, location, stage at diagnosis, treatment, and survival data for 1,365 patients diagnosed with sinonasal cancers were extracted from the SEER database. All statistical analyses were performed using SAS 9.5. The Fine and Grey method was used to assess covariate impacts.
Results
Medicaid patients were more likely to live in counties with lower educational levels (8.32% vs. 6.46% below ninth grade education, P < .0001) and lower median household incomes ($56,316 vs. $60,284, P = .0004). Medicaid patients presented with later (T3‐T4) stage disease compared to other insurances (P = .0007) and larger tumor size (P = .011). Medicaid patients were less likely to have surgery recommended (P = .0017) or receive surgery as part of their treatment (P = .0033). Analysis of histology‐specific 5‐year survival rates were lower for Medicaid patients with squamous cell carcinoma (SCCA) (P = .016).
Conclusions
This is the first and largest study to examine how education and insurance status may impact treatment and outcomes in sinonasal cancers. It is the first using this method of examining other covariates and informing associated risk. Patients with Medicaid and less education present with larger sinonasal cancers. They are less likely to have surgery recommended or receive surgery. For SCCA, the most common histology, Medicaid patients have significantly worse survival. Further emphasis on education and improving health literacy is needed in the at‐risk Medicaid populations.
Level of Evidence
NA
Laryngoscope, 2019
Education and insurance status: Impact on treatment and survival of sinonasal cancer patients
Pratima Agarwal BA Eric A. Jones MS Anand K. Devaiah MD
First published: 04 June 2019 https://doi.org/10.1002/lary.28097
Editor's Note: This Manuscript was accepted for publication on May 16, 2019.
Presented at the Triological Society Annual Meeting at COSM, Austin, Texas, U.S.A., May 3–4, 2019.
p.a. contributed to this work through study conception and design, data extraction, data analysis, data interpretation, and manuscript draft and edits. e.a.j. contributed to this work through data analysis and manuscript revision. a.k.d. contributed to this work through study conception and design, data interpretation, manuscript drafting and edits, and final manuscript approval.
The authors have no funding, financial relationships, or conflicts of interest to disclose.
Read the full text
ePDFPDFTOOLS SHARE
Abstract
Objectives/Hypothesis
To understand the impact of education and insurance as social determinants of health on sinonasal cancer treatment and outcomes.
Study Design
Retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER) database.
Methods
Demographics, tumor characteristics, location, stage at diagnosis, treatment, and survival data for 1,365 patients diagnosed with sinonasal cancers were extracted from the SEER database. All statistical analyses were performed using SAS 9.5. The Fine and Grey method was used to assess covariate impacts.
Results
Medicaid patients were more likely to live in counties with lower educational levels (8.32% vs. 6.46% below ninth grade education, P < .0001) and lower median household incomes ($56,316 vs. $60,284, P = .0004). Medicaid patients presented with later (T3‐T4) stage disease compared to other insurances (P = .0007) and larger tumor size (P = .011). Medicaid patients were less likely to have surgery recommended (P = .0017) or receive surgery as part of their treatment (P = .0033). Analysis of histology‐specific 5‐year survival rates were lower for Medicaid patients with squamous cell carcinoma (SCCA) (P = .016).
Conclusions
This is the first and largest study to examine how education and insurance status may impact treatment and outcomes in sinonasal cancers. It is the first using this method of examining other covariates and informing associated risk. Patients with Medicaid and less education present with larger sinonasal cancers. They are less likely to have surgery recommended or receive surgery. For SCCA, the most common histology, Medicaid patients have significantly worse survival. Further emphasis on education and improving health literacy is needed in the at‐risk Medicaid populations.
Level of Evidence
NA
Laryngoscope, 2019
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