{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T10:23:34Z","timestamp":1790072614890,"version":"4.0.1"},"reference-count":19,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2007,6,11]],"date-time":"2007-06-11T00:00:00Z","timestamp":1181520000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2007,7,15]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>BACKGROUND.<\/jats:title><jats:p>Although patients who have early\u2010stage oropharyngeal cancer can be treated with little impairment of function, the treatment of advanced disease can result in decreased quality of life and mortality. Patients without insurance and with other barriers to access to care may delay seeking medical attention for early symptoms, resulting in more advanced disease at presentation. In this study, the authors examined whether patients who had no insurance or who were covered by Medicaid insurance were more likely to present with advanced oropharyngeal cancer.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS.<\/jats:title><jats:p>In this retrospective cohort study from the National Cancer Database from 1996 to 2003, patients with known insurance status who were diagnosed with invasive oropharyngeal cancer at Commission on Cancer facilities (n = 40,487) were included. Adjusted and unadjusted logistic regression models were used to analyze the likelihood of presenting with more advanced stage disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS.<\/jats:title><jats:p>After controlling for other sociodemographic characteristics, patients with advanced oropharyngeal cancer at diagnosis were more likely to be uninsured (odds ratio [OR], 1.37; 95% confidence interval [95% CI], 1.21\u20131.25) or covered by Medicaid (OR, 1.31; 95% CI, 1.19\u20131.46) compared with patients who had private insurance. Similarly, patients were most likely to present with the largest tumors (T4 disease) if they were uninsured (OR, 2.82; 95% CI, 2.46\u20133.23) or covered by Medicaid (OR, 2.95; 95% CI, 2.63\u20133.31). They also were more likely to present with the greatest degree of lymph node involvement (N3) if they were uninsured (OR, 2.06; 95% CI, 1.76\u20132.40) or covered by Medicaid (OR, 1.66; 95% CI, 1.45\u20131.90).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS.<\/jats:title><jats:p>Individuals who lacked insurance or had Medicaid coverage were at the greatest risk for presenting with advanced oropharyngeal cancer. In the current study, the results for the Medicaid group may have been influenced by the postdiagnostic enrollment of uninsured patients. Insurance coverage appeared to be a highly modifiable predictor of cancer stage. The findings indicated that it is important to consider the impact of insurance coverage on disease stage at diagnosis and associated morbidity, mortality, and quality of life. Cancer 2007. \u00a9 2007 American Cancer Society.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.22788","type":"journal-article","created":{"date-parts":[[2007,6,11]],"date-time":"2007-06-11T11:16:37Z","timestamp":1181560597000},"page":"395-402","source":"Crossref","is-referenced-by-count":92,"title":["The impact of health insurance status on stage at diagnosis of oropharyngeal cancer"],"prefix":"10.1002","volume":"110","author":[{"given":"Amy Y.","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole M.","family":"Schrag","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael T.","family":"Halpern","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth M.","family":"Ward","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2007,6,29]]},"reference":[{"key":"e_1_2_5_2_2","doi-asserted-by":"publisher","DOI":"10.3322\/canjclin.56.2.106"},{"key":"e_1_2_5_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra001375"},{"key":"e_1_2_5_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0889-8588(05)70087-3"},{"key":"e_1_2_5_5_2","unstructured":"Surveillance Research Program. National Cancer Institute SEER*STAT software version 6.2.3. Available at URL:www.seer.cancer.gov\/seerstat[Accessed November 2006]."},{"key":"e_1_2_5_6_2","first-page":"1","article-title":"Dental services and oral health","volume":"183","author":"Bloom B","year":"1992","journal-title":"Vital Health Stat."},{"key":"e_1_2_5_7_2","volume-title":"Health, United States 2005 with Chartbook on Trends in the Health of Americans","author":"National Center for Health Statistics","year":"2005"},{"key":"e_1_2_5_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4757-3656-4"},{"key":"e_1_2_5_9_2","unstructured":"Commission on Cancer. Site by Stage Distribution of Cases Reported to the NCDB: Diagnosis Year 2003. Available at URL:http:\/\/www.facs.org\/cancer\/ncdb\/ver7_site_stage_2003.htm[Accessed November 2006]."},{"key":"e_1_2_5_10_2","unstructured":"Commission on Cancer. Registry Operations and Data Standards (ROADS). Available at URL:http:\/\/www.facs.org\/cancer\/coc\/roads\/roads1998.pdf[Accessed November 2006]."},{"key":"e_1_2_5_11_2","unstructured":"Commission on Cancer. Registry Operations and Data Standards (ROADS). Available at:http:\/\/www.facs.org\/cancer\/coc\/roads\/roads1996.pdf[Accessed November 2006]."},{"key":"e_1_2_5_12_2","volume-title":"International Classification of Diseases for Oncology, ICD\u2010O","author":"Fritz A","year":"2000"},{"key":"e_1_2_5_13_2","unstructured":"Centers for Medicare and Medicaid Services. Available at URL:http:\/\/www.medicare.gov\/default.asp [Accessed November 2006]."},{"key":"e_1_2_5_14_2","unstructured":"Bureau of the Census. United Status Census Report. Available at URL:http:\/\/www.census.gov\/geo\/www\/us_regdiv.pdf; [Accessed November 2006]."},{"key":"e_1_2_5_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199803000-00004"},{"key":"e_1_2_5_16_2","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/91.16.1409"},{"key":"e_1_2_5_17_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.295.17.2027"},{"key":"e_1_2_5_18_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.MLR.0000065126.73750.D1"},{"key":"e_1_2_5_19_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.20954"},{"key":"e_1_2_5_20_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.22.6.244"}],"container-title":["Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fcncr.22788","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cncr.22788","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T09:20:19Z","timestamp":1760260819000},"score":1,"resource":{"primary":{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/10.1002\/cncr.22788"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2007,6,29]]},"references-count":19,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2007,7,15]]}},"alternative-id":["10.1002\/cncr.22788"],"URL":"https:\/\/doi.org\/10.1002\/cncr.22788","archive":["Portico"],"relation":{},"ISSN":["0008-543X","1097-0142"],"issn-type":[{"value":"0008-543X","type":"print"},{"value":"1097-0142","type":"electronic"}],"subject":[],"published":{"date-parts":[[2007,6,29]]}}}