Differences in stage of diagnosis for oral and pharyngeal cancer OPC based on race, ethnicity, and socioeconomic status have been documented with poor and Blacks having the poorest outcomes. To understand points of intervention, we examined how stage at diagnosis is influenced by gender, race, ethnicity, 3rd party payer, and marital status separately for oral sites and pharyngeal sites. Oral sites include squamous cell carcinomas of tongue, floor of mouth, and palate; Pharyngeal sites include squamous cell carcinomas of base of tongue, tonsil, hypopharynx, and oropharynx. Our rationale for separating these sites is the dramatic difference in stage of diagnosis between oral and pharyngeal (1). In this analysis, we add a modeling component to our previous work and focus on the effect of insurance on stage of diagnosis.

Methods: OPC cancer patients diagnosed between 2000 and 2008 were examined using data from the Florida Cancer Data System. A total of 12938 patients with OPC cancers were identified, with 4531 oral cavity cases and 8407 pharynx cases. Overall, 72.2% of patients were male, 92% were white, and 8.5% were Hispanic. The primary outcome variable stage of diagnosis was dichotomized into: localized versus late (regional and distant) stage diagnosis. Two logistic regression models, separated for oral SCC and pharyngeal SCC, were built with predictor variables including gender, race, ethnicity, insurance used, and marital status. Categories of insurance coverage were: 1) No insurance, 2) Private insurance, 3) Medicaid, 4) Medicare, and 5) Other. Age at diagnosis and year of diagnosis were controlled for the models.

Results: Compared to Whites, Blacks were less likely to have private insurance (19.47% versus 30.64% for Whites) but more likely to have no insurance (12.46% versus 7.06% for Whites) and Medicaid coverage (20.74% versus 6.31% for Whites). Compared to Non-Hispanics, Hispanics were more likely to have no insurance (12.49% versus 7.01% for Non-Hispanics) and Medicaid coverage (15.11% versus 6.74% for Non-Hispanics). However, the percentages covered by private insurance were similar for Hispanics (28.87%) and Non-Hispanics (29.83%). The percentage with Medicare coverage were similar across groups ranging from 33%-39%.

Insurance Race Ethnicity

White Black Non-Hispanic Hispanic

No insurance 7.06% 12.46% 7.01% 12.49%

Private 30.64% 19.47% 29.83% 28.87%

Medicaid 6.31% 20.74% 6.74% 15.11%

Medicare 39.9% 33.01% 39.91% 33.48%

other 16.09% 14.31% 16.50% 10.05%

Based on the regression analysis, having private insurance (OR=0.48, p<0.001; OR=0.66, p=0.004) or Medicare (OR=0.46, p<0.001; OR=0.54, p<0.001) coverage were protective compared to no insurance in having a late-stage diagnosis at either oral or pharyngeal sites. On the other hand, being enrolled in Medicaid was no different than having no insurance in stage of diagnosis for both oral and pharyngeal cancer. Many of the other observed relationships were as expected: being male was a risk factor for late stage dx for both oral and pharyngeal cancer (OR=1.52, p<0.001; OR=1.54, p<0.001) as was being Hispanic (OR=1.27, p=0.021; OR=1.29, p=0.027). Being Black was a risk factor for late stage oral cancer diagnosis (OR=2.00, p<0.001) but not pharyngeal cancer (OR=1.18, p=0.1596). Being married was protective for oral and pharyngeal sites (OR=.74, p<0.001; OR=0.80, p<0.001, respectively).

Conclusions: Medicare and private insurance were protective against late stage diagnosis. Benefits associated with Medicaid coverage provide no additional protection for late stage diagnosis compared to having no insurance pointing to a clear need for a review of the diagnostics services available.

1. Guo Y, McGorray SP, Riggs CE, Jr., Logan HL. Racial disparity in oral and pharyngeal cancer in Florida in 1991-2008: mixed trends in stage of diagnosis. Community Dentistry and Oral Epidemiology 2012;72(1):68-74.

Citation Format: Henrietta L. Logan. Type of insurance affects risk of late-stage oral and pharyngeal cancer diagnosis. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr C14.