{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T18:43:44Z","timestamp":1760985824916,"version":"3.40.5"},"reference-count":40,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2019,11,13]],"date-time":"2019-11-13T00:00:00Z","timestamp":1573603200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Otolaryngology"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>The United States has a heterogenous health insurance landscape for patients &lt;65\u00a0years. We sought to characterise the impact of primary payer on overall survival (OS) in insured patients younger than 65 with head and neck squamous cell carcinoma (HNSCC) treated with definitive radiotherapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design\/Study\/Participants<\/jats:title><jats:p>The National Cancer Database was queried for patients &lt;65 years old diagnosed from 2004 to 2014 undergoing definitive radiotherapy\u00a0\u00b1\u00a0chemotherapy for cancers of the nasopharynx, oropharynx, hypopharynx and larynx. Uninsured patients and oropharyngeal cancers without known HPV status were excluded.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome<\/jats:title><jats:p>Overall survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall, 27\u00a0292 insured patients were identified, including 17\u00a0060 (62.5%) with private insurance. Median follow\u2010up was 52.1\u00a0months. In multivariable models, patients receiving Medicaid (HR\u00a0=\u00a01.66, 95% CI 1.57\u20101.75,<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001), Medicare (HR\u00a0=\u00a01.64, 95% CI 1.55\u20101.73,<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001) and other government insurance (HR\u00a0=\u00a01.44, 95% CI 1.29\u20101.,<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001) had independently increased mortality in comparison to those with private insurance. In propensity score\u2010matched cohorts, 5\u2010year OS was 65.5% vs 50.6% for privately vs government\u2010insured patients, respectively (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001). In multivariable subgroup analysis, private insurance was associated with improved survival in all subgroups. However, the magnitude of this effect was most pronounced in patients with HPV\u2010positive oropharyngeal cancer vs non\u2010HPV\u2010related cancer (interaction<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001), younger patients (interaction<jats:italic>P<\/jats:italic>\u00a0=\u00a0.001), and those without comorbidity (interaction<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Patients &lt;65 with HNSCC undergoing definitive radiation with private health insurance have markedly longer survival relative to patients with government\u2010sponsored insurance. This illustrates that increasing access to care may be necessary, but is not sufficient, to mitigate the significant disparities in the US healthcare system.<\/jats:p><\/jats:sec>","DOI":"10.1111\/coa.13467","type":"journal-article","created":{"date-parts":[[2019,10,29]],"date-time":"2019-10-29T13:17:13Z","timestamp":1572355033000},"page":"63-72","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Impact of insurance on survival in patients\u00a0&lt;\u00a065 with head &amp; neck cancer treated with radiotherapy"],"prefix":"10.1111","volume":"45","author":[{"given":"Mark P.","family":"Sittig","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Cedars\u2010Sinai Medical Center Los Angeles CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Luu","sequence":"additional","affiliation":[{"name":"Biostatistics and Bioinformatics Research Center Cedars\u2010Sinai Medical Center Los Angeles CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emi J.","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of California San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin","family":"Scher","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology Cedars\u2010Sinai Medical Center Los Angeles CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alain","family":"Mita","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology Cedars\u2010Sinai Medical Center Los Angeles CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen L.","family":"Shiao","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Cedars\u2010Sinai Medical Center Los Angeles CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diana J.","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Cedars\u2010Sinai Medical Center Los Angeles CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jon","family":"Mallen\u2010St. Clair","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Head and Neck Surgery Cedars\u2010Sinai Medical Center Los Angeles CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allen S.","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Head and Neck Surgery Cedars\u2010Sinai Medical Center Los Angeles CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7484-3631","authenticated-orcid":false,"given":"Zachary S.","family":"Zumsteg","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Cedars\u2010Sinai Medical Center Los Angeles CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,11,13]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/CA.2007.0011"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMhpr1411701"},{"key":"e_1_2_9_4_1","unstructured":"ClarkeTC NorrisT Early SchillerJS.Release of selected estimates based on data from the 2016 national health interview survey.https:\/\/www.cdc.gov\/nchs\/data\/nhis\/earlyrelease\/earlyrelease201705.pdf. 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