High rates of postoperative radiotherapy delay in head and neck cancer before and after Medicaid expansion
John Pang, Farhoud Faraji, Erik Risa, Loren K. Mell, Jeffrey Houlton, Joseph A. Califano
Abstract
BACKGROUND: The objective is to study the effect of Medicaid expansion on postoperative radiation therapy (PORT) delay in patients with head and neck squamous cell carcinoma (HNSCC). METHODS: Patients from the National Cancer Database with HNSCC undergoing curative-intent surgery in the 2 years before and after Medicaid expansion were analyzed (n = 11 717) using the difference-in-differences technique to study the effect on PORT delay. RESULTS: The rate of PORT delay before and after expansion was 66.0% and 66.9%, respectively. Medicaid patients had more frequent PORT delay than privately insured patients (pre-expansion 77.2% vs. 59.4%, p < 0.001; post-expansion 76.5% vs. 60.9%, p < 0.001). Medicaid expansion had no effect on PORT delay [hazard ratio 0.95, 95% confidence interval 0.81-1.12]. Supplemental analyses revealed that pathologic stage, number of treating facilities, and comorbidities were among several factors associated with PORT delay in the cohort. CONCLUSION: PORT delay is unacceptably frequent. Improvement in timely adjuvant therapy requires more than Medicaid expansion.