{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T08:35:10Z","timestamp":1778834110969,"version":"3.51.4"},"reference-count":21,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2023,1,1]],"date-time":"2023-01-01T00:00:00Z","timestamp":1672531200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Otolaryngology - Head &amp; Neck Surgery"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p> Insurance 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. <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p> This is a retrospective, population-based cohort study using the Survival, Epidemiology, and End Results Program database. The population included all adult (age\u2009\u2265\u200918) 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. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p> The 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\u00a0years 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\u2009=\u20090.59, 95% CI 0.46\u20130.77, p\u2009&lt;\u20090.0001 [Medicaid vs. Insured]; and OR\u2009=\u20090.48, 95% CI 0.31\u20130.73 p\u2009=\u20090.001 [Uninsured vs. Insured]), however these differences did not persist when considering only those patients treated following the 2014 expansion of the ACA. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p> Insurance 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. <\/jats:p><\/jats:sec><jats:sec><jats:title>Graphical Abstract<\/jats:title><jats:p> <\/jats:p><\/jats:sec>","DOI":"10.1186\/s40463-022-00608-3","type":"journal-article","created":{"date-parts":[[2023,4,18]],"date-time":"2023-04-18T12:03:37Z","timestamp":1681819417000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["The effect of insurance status on treatment modality in advanced oral cavity cancer"],"prefix":"10.1177","volume":"52","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5925-445X","authenticated-orcid":false,"given":"Shanmugappiriya","family":"Sivarajah","sequence":"first","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta Hospital, 8440 112 St NW, T6G 2B7, Edmonton, AB, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Ghods-Esfahani","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Alberta, Edmonton, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra","family":"Quimby","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fawaz","family":"Makki","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta Hospital, 8440 112 St NW, T6G 2B7, Edmonton, AB, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giacomo","family":"Montagna","sequence":"additional","affiliation":[{"name":"Department of Surgery, Memorial Sloan Kettering Cancer Center, Breast Service, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hadi","family":"Seikaly","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta Hospital, 8440 112 St NW, T6G 2B7, Edmonton, AB, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2023,1,1]]},"reference":[{"key":"bibr1-s40463-022-00608-3","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21387"},{"key":"bibr2-s40463-022-00608-3","unstructured":"National cancer institute. Cancer Stat facts: oral cavity and pharynx cancer. Survival, epidemiology, and end results program. https:\/\/seer.cancer.gov\/statfacts\/html\/oralcav.html. Published 2017. Accessed May 25, 2020."},{"key":"bibr3-s40463-022-00608-3","unstructured":"National institute of health. Lip and oral cavity cancer treatment (Adult) (PDQ\u00ae)\u2013Health Professional Version. National Cancer Institute."},{"key":"bibr4-s40463-022-00608-3","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0000000000000859"},{"key":"bibr5-s40463-022-00608-3","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.31106"},{"key":"bibr6-s40463-022-00608-3","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.22786"},{"key":"bibr7-s40463-022-00608-3","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.22788"},{"key":"bibr8-s40463-022-00608-3","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.24774.The"},{"key":"bibr9-s40463-022-00608-3","doi-asserted-by":"publisher","DOI":"10.12659\/MSM.913282"},{"key":"bibr10-s40463-022-00608-3","unstructured":"StataCorp. 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