Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, UC San Diego School of Medicine, San Diego, California, USA.
Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA.
Head Neck. 2021 Sep;43(9):2672-2684. doi: 10.1002/hed.26736. Epub 2021 May 17.
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).
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.
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.
PORT delay is unacceptably frequent. Improvement in timely adjuvant therapy requires more than Medicaid expansion.
本研究旨在探讨医疗补助计划扩大覆盖范围对头颈部鳞状细胞癌（HNSCC）患者术后放疗（PORT）延迟的影响。
采用差异分析法，分析了在医疗补助计划扩大覆盖范围前后 2 年内接受根治性手术治疗的 HNSCC 患者（n=11717），以评估 PORT 延迟的影响。
在扩大覆盖范围前后，PORT 延迟的发生率分别为 66.0%和 66.9%。与私人保险患者相比，医疗补助患者的 PORT 延迟更频繁（扩大前：77.2%比 59.4%，p<0.001；扩大后：76.5%比 60.9%，p<0.001）。医疗补助计划扩大覆盖范围对 PORT 延迟没有影响[风险比 0.95，95%置信区间 0.81-1.12]。补充分析显示，病理分期、治疗机构数量和合并症是队列中与 PORT 延迟相关的几个因素之一。
PORT 延迟的发生率高得令人无法接受。改善辅助治疗的及时性不仅仅需要扩大医疗补助计划。
