Individuals with advanced-stage laryngeal cancer at diagnosis were more likely to be uninsured or covered by Medicaid than to have private insurance, according to a report in the August issue of Archives of Otolaryngology-Head & Neck Surgery, one of the JAMA/Archives journals.
Laryngeal [voice box] cancer is diagnosed in nearly 10,000 men and women in the United States annually and is among the most common cancers in the upper aerodigestive tract, according to background information in the article. Stage at diagnosis is a key factor influencing prognosis and treatment. It is plausible that individuals without health insurance or with other barriers to health care access would be less likely to seek medical attention for these symptoms and thus present at a later stage with worse survival and fewer options for treatment.
Amy Y. Chen, M.D., M.P.H., of Emory University and the American Cancer Society, Atlanta, and colleagues analyzed medical and insurance information from 61,131 patients diagnosed between 1996 and 2003 to examine the relationship between patients insurance status and overall stage of cancer and tumor size at diagnosis. Stage at diagnosis was categorized as early (stages I and II) or advanced (stages III and IV) and tumor size (T stage) at diagnosis was categorized as T1, T2, T3 or T4, with T4 being the largest. Patient race, sex, age, U.S. census region of residence, education and ZIP code as well as type of treatment facility were also noted.
There were 32,665 (53.4 percent) [patients] with early-stage disease and 28,466 (46.6 percent) with advanced-stage disease. The distribution of T stage included 22,693 (37.1 percent) with T1 disease, 15,111 (24.7 percent) with T2 disease, 13,541 (22.2 percent) with T3 disease and 9,786 (16 percent) with T4 disease, the authors write. Patients with advanced-stage disease or more advanced T stage were more likely to be uninsured or have Medicaid or other government-funded plans than were those with early-stage disease.
Patients who were female, black, between ages 18 and 56 or who live in ZIP codes with low proportions of high school graduates or with low median household incomes were more likely to be diagnosed with an advanced stage of the disease and/or larger tumors. Those treated at teaching/research facilities were also more likely to have advanced disease.
In conclusion, our analyses provide the first assessment, to our knowledge, of the strong association between medical insurance and stage of laryngeal cancer at diagnosis among a large, generalizable cohort. Insurance coverage is a highly modifiable factor that affects not only tumor associated morbidity and mortality but also quality of life and economic costs, the authors conclude.
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