Abstract B088: Health insurance status, stage at presentation and survival among female patients with head and neck cancer
Authors: Panth Neelima , Simpson Matthew C. , Sethi Rosh K.V. , Varvares Mark A. , Osazuwa-Peters Nosayaba 
Published: August 2020

Abstract
Introduction: Head and neck cancer epidemiology has historically focused on the burden of disease among males. Despite a concerning increase in the incidence of certain types of head and neck cancer among females, females with head and neck cancer continue to represent an understudied and overlooked patient population. While previous studies have established that health insurance status is associated with mortality and stage at presentation among patients with head and neck cancer, the impact of health insurance on female patients with head and neck cancer is not well understood. This study describes incidence trends in stage at presentation and investigates the association between health insurance status, stage at presentation and survival among female patients with head and neck cancer.
Methods: This retrospective cohort study included 18,923 female patients from the Surveillance, Epidemiology, and End Results (SEER) database (2007 - 2014), aged ≥ 18 years, and diagnosed with a malignant primary head and neck cancer. Incidence trends for stage at presentation was estimated using Joinpoint regression analysis. Binary logistic regression estimated odds of presenting with late-stage disease. The association between health insurance status (private insurance, uninsured and Medicaid), and stage of presentation (AJCC stages I-IV) on the outcomes of interest (overall and disease-specific survival) was estimated using Fine and Gray proportional hazards models, while adjusting for covariates, including age at diagnosis, race/ethnicity, marital status, and tumor site.
Results: The incidence of stage IV head and neck cancer in this subpopulation rose by 1.24% from 2007-2014 (APC=1.24, 95% CI 0.30, 2.20). Patients with Medicaid (aOR=1.59, 95% CI 1.45, 1.74) and who were uninsured (aOR=1.73, 95% CI 1.47, 2.04) were more likely to be diagnosed with advanced-stage (stages III/IV) head and neck cancer. Cancers of the hypopharynx (81%) and oropharynx (83%) were most likely to be diagnosed at an advanced stage. Female patients with Medicaid (aHR=1.47, 95% CI 1.38, 1.56) and who were uninsured (aHR=1.45, 95% CI 1.29, 1.63) were more likely to die from any cause compared to privately insured patients. Medicaid (aHR=1.34, 95% CI 1.24, 1.44) and uninsured (aHR=1.41, 95% CI 1.24, 1.60) patients also had a greater hazard of death from head and neck cancer compared to privately insured patients.
Conclusions: There has been a significant increase in the incidence of advanced-stage presentation for female head and neck cancer patients in the United States since 2007. Patients who are either uninsured or are on Medicaid are more likely to present with late-stage disease and die earlier than those with private insurance. This study illustrates the need to evaluate and address the unique burden of head and neck cancer among females. It is critical that physicians are aware of the trends in head and neck cancer among females and the need for further evaluation or referral of their high-risk patients when concerned.
Citation Format: Neelima Panth, Matthew C. Simpson, Rosh K.V. Sethi, Mark A. Varvares, Nosayaba Osazuwa-Peters. Health insurance status, stage at presentation and survival among female patients with head and neck cancer [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B088.