Evidence map›Paper›PMID 37072807›Full record

ArticleJournal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale2023

The effect of insurance status on treatment modality in advanced oral cavity cancer.

Shanmugappiriya Sivarajah, Daniel Ghods-Esfahani, Alexandra Quimby, Fawaz Makki, Giacomo Montagna, Hadi Seikaly

Open access · goldAbstract read
In one paragraph

Article in Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
1.0field-weighted citation impact, top 25% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 3 citations in OpenAlex.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 4 institutions in 2 countries.

Shanmugappiriya SivarajahDepartment of Otolaryngology-Head and Neck Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta Hospital, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada. shanmuga@ualberta.ca.ORCID http://orcid.org/0000-0001-5925-445X
Daniel Ghods-EsfahaniDepartment of Medicine, University of Alberta, Edmonton, Canada.
Alexandra QuimbyDepartment of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Canada.
Fawaz MakkiDepartment of Otolaryngology-Head and Neck Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta Hospital, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada.
Giacomo MontagnaDepartment of Surgery, Memorial Sloan Kettering Cancer Center, Breast Service, New York, USA.
Hadi SeikalyDepartment of Otolaryngology-Head and Neck Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta Hospital, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada.
University of Alberta Hospital · CAMemorial Sloan Kettering Cancer Center · USUniversity of Alberta · CAUniversity of Ottawa · CA

Funding

X-RAY CRYSTALLOGRAPHYP30CA008748 · NCI · SLOAN-KETTERING INSTITUTE FOR CANCER RES · PI Hongbiao Carl Lekaye · 1985 to 2026
$347.4M
NCI NIH HHS P30 CA008748
6 · The paper itself

Abstract

backgroundInsurance status has been shown to impact survival outcomes. We sought to determine whether insurance affects the choice of treatment modality among patients with advanced (T4) oral cavity squamous cell carcinoma.

methodsThis is a retrospective, population-based cohort study using the Survival, Epidemiology, and End Results Program database. The population included all adult (age ≥ 18) patients with advanced (T4a or T4b) oral cavity squamous cell carcinoma diagnosed from 2007 to 2016. The main outcome was the odds of receiving definitive treatment, defined as primary surgical resection. Insurance status was categorized into uninsured, any Medicaid, and insured groups. Univariable, multivariable, and subgroup analyses were performed.

resultsThe study population consisted of 2628 patients, of whom 1915 (72.9%) were insured, 561 (21.3%) had Medicaid, and 152 (5.8%) were uninsured. The multivariable model showed that patients who were 80 years or older, unmarried, received treatment in the pre-Affordable Care Act (ACA) period, and who were on Medicaid or uninsured were significantly less likely to receive definitive treatment. Insured patients were significantly more likely to receive definitive treatment compared to those on Medicaid or uninsured (OR = 0.59, 95% CI 0.46-0.77, p < 0.0001 [Medicaid vs. Insured]; and OR = 0.48, 95% CI 0.31-0.73 p = 0.001 [Uninsured vs. Insured]), however these differences did not persist when considering only those patients treated following the 2014 expansion of the ACA.

conclusionsInsurance status is significantly associated with treatment modality among adults with advanced stage (T4a) oral cavity squamous cell carcinoma. These findings support the premise of expanding insurance coverage in the US.

Indexed as

Carcinoma, Squamous CellHead and Neck NeoplasmsAdultCohort StudiesHumansInsurance CoverageMouthPatient Protection and Affordable Care ActRetrospective StudiesSquamous Cell Carcinoma of Head and NeckUnited StatesHead and neck cancerInsuranceSurgeryTreatment

Identifiers

PMID37072807
PMCPMC10114465
OpenAlexW4366275680

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.