Background

It is estimated that there will be 13,560 new cases of larynx cancer and an estimated 3,640 people will die of this disease, in 2015. There are many risk factors affecting survival outcomes in larynx cancer. Previous studies on laryngeal cancer found several discrepancies for mortality in patients with various racial and socioeconomic backgrounds. However, further studies indicate that reduced survival outcomes for African-American or uninsured patients are not affected by tumor biology hinting that some disparities can be overcome through healthcare equity. In the wake of the Affordable Care Act and its impact on insurance coverage, evaluating the effect of insurance status on health outcomes is urgently necessary. This study characterizes the relationship between payer status and overall survival for larynx cancer patients by analyzing data from the large National Cancer Data Base (NCDB).

Methods

We analyzed data from the National Cancer Data Base of 22,177 patients with laryngeal cancer of stage I and II who received laser surgery or radiation treatment. The outcome variable was overall survival and the primary predictor variable was payer status. Additional variables addressed and adjusted for included sex, age, race, Charlson Comorbidity index, education, income, distance traveled facility type, diagnosing/treating facility, treatment delay, stage, grade and type of treatment received.

Results

Among these 22,177 patients, approximately 90% were over age 50 years, and 80% of the patients were male. 48.5%, 39.4%, 5.4%, 3.8% and 2.7% of patients had Medicare, private, Medicaid, uninsured, and unknown status, respectively. There was 83% of patients received radiation treatment only whereas 5.2% received laser surgery and 3.2% received both laser surgery and radiation.

In multivariate analysis, after adjusting for secondary predictor variables, payer status was a statistically significant predictor of overall survival.

Relative to privately insured patients, patients with Medicaid had a 76% increased risk, no insurance had a 29% increased risk, Medicare had a 38% increased risk and unknown insurance had a 25% increased risk of mortality. Compared to patients without treatment (no radiation, no laser surgery), patient with laser surgery, patients with laser and radiation therapy were 77% and 76% less likely to die while patients receiving radiation therapy was not significant different from no treatment.

Conclusion

We observed that payer status has a statistically significant relationship with overall survival from laryngeal cancer. This remained true after adjusting for other predictive factors. Medicaid Medicare and uninsured patients had the highest mortality while privately insured patients had the lowest mortality. Further research is necessary how the disparities associated with different types of insurance result in inferior treatment outcomes and the ways to address them.

Citation Format: Samip R. Master, Peter Zhang, Glenn Mills, Runhua Shi. The effect of payer status on early stage laryngeal cancer survival. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1429.