Insurance Status as a Predictor of Treatment in Human Papillomavirus Positive Oropharyngeal Cancer

Abstract

Objectives: The link between human papillomavirus (HPV) and oropharyngeal cancer (OPC) is well known. Locally advanced, HPV-positive OPC (HPV OPC) can be treated with either chemoradiation or primary surgery with or without adjuvant therapy. Head and neck cancer patients with government insurance or uninsured have been shown to have worse prognosis than similar patients with private insurance. In this study, we aimed to determine if insurance status would predict treatment modality in patients with HPV OPC.

Study design: A retrospective analysis using the National Cancer Database (NCDB).

Methods: The National Cancer Database was used to identify patients with HPV OPC who underwent primary surgery or primary chemoradiation from 2010-2015. Insurance status was categorized as government, private, or no insurance. The relationship between insurance status and treatment was investigated using Chi square and multivariate regression models. Kaplan-Meier analyses were performed comparing overall survival (OS) by insurance status.

Results: There were 10,606 patients were included. There was a statistically significant correlation between insurance status and primary treatment modality for HPV OPC (P < .001). Patients with government insurance were 19.3% less likely to undergo surgery and uninsured patients were 36.9% less likely to undergo primary surgery when compared to those with private insurance (P < .001), even after correcting for TNM stage in multivariate analysis. There was an improved 5-year OS for patients with private insurance (86.6%) versus both government insurance (68.4%) and no insurance (69.9%) (P < .001).

Conclusions: Patients with private insurance are more likely to undergo primary surgery in HPV OPC and have improved overall survival.

Level of evidence: 4 Laryngoscope, 131:776-781, 2021.

Keywords: HPV; Oropharyngeal neoplasms; head and neck cancer; healthcare disparities, health insurance; squamous cell carcinoma of head and neck; transoral robotic surgery.