Insurance tied to survival odds in head/neck cancers

NEW YORK (Reuters Health) - People with cancers of the head or neck seem to have better survival odds if they have private health insurance, research hints.

Head and neck cancers include cancers of the mouth, throat, nasal cavity, salivary glands and lymph nodes of the neck. Most cases are linked to smoking, with excessive drinking being the other major risk factor.

But while those habits may raise the odds of developing head and neck cancers, the new findings, reported in the journal Cancer, suggest that insurance coverage influences the odds of surviving.

Researchers found that among more than 1,200 patients treated at the Pittsburgh Medical Center between 1998 and 2007, those with private insurance had better survival rates than those with no insurance, as well as patients on Medicaid or Medicare disability.

Medicaid is the federal health insurance program for the poor; Medicare disability covers people younger than 65 who cannot work because of a serious disability or illness.

In this study, patients who were uninsured or on Medicaid were 50 percent more likely to die than privately insured patients. Those on Medicare disability had a 69 percent higher risk of dying -- with factors such as age, race, income and smoking and drinking history taken into account.

Instead, the poorer survival seemed to be partly explained by later diagnosis. People without private insurance generally had more-advanced cancer by the time they saw a doctor, according to the researchers, led by Joseph Kwok of the University of Pittsburgh Cancer Institute.

It's possible, they write, that these patients are less likely to get screened for head and neck cancers, or may have to delay treatment after a diagnosis.

The findings are based on 1,231 patients who underwent treatment for some form of head and neck cancer. Of the 547 patients with private insurance, 145 died during the study period; of 128 patients who were on Medicaid or were uninsured, 50 died; of 81 on Medicare disability, 39 died.

Older adults covered by traditional Medicare had similar survival odds as patients on private insurance.

Later diagnosis appeared to be a major factor in the link between insurance and cancer survival, Kwok and his colleagues found.

Across cancer types, uninsured and Medicaid patients were at greater risk of having advanced cancer than their privately insured counterparts. For example, when it came to laryngeal cancer -- cancer of the voice box -- they were seven times more likely to be at an advanced stage at the time of diagnosis.

Even though Medicaid patients have insurance coverage, the researchers note, they -- like the uninsured -- may be less likely to have routine dental check-ups, which often catch signs of oral cancer early.

They also point to other barriers -- like transportation problems or getting time off from work to visit the doctor -- that may prevent some uninsured and Medicaid/Medicare disability patients from having any early cancer symptoms assessed, or from starting treatment after a diagnosis.

On a more positive note, Kwok's team did find that insurance had no influence over the risk of a cancer recurrence. That, they say, suggests that once patients begin treatment, they receive comparable care regardless of insurance status.

SOURCE: Cancer, November 20, 2009.