Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts.
Oral Medicine and Oral Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami.
JAMA Otolaryngol Head Neck Surg. 2024 Sep 1;150(9):811-818. doi: 10.1001/jamaoto.2024.2260.
Patients undergoing treatment for head and neck cancer (HNC) experience oral complications requiring substantial dental treatment. This treatment is commonly not reimbursed by medical insurers, presenting a potential financial burden for patients.
To characterize the dental care needs and associated cost burden for patients with HNC.
DESIGN, SETTING, AND PARTICIPANTS: This survey study included Head and Neck Cancer Alliance (HNCA) members who were surveyed from March 23 to October 27, 2023, using Qualtrics. The survey was promoted using the HNCA's social media and email list. Data analysis was performed between October 2023 and May 2024.
Main outcomes were oral and dental complications of cancer treatment among patients with HNC, the association of cancer treatment with dental care use, and costs of associated dental treatment.
Of 100 individuals administered the survey, 85 (85%) completed all required questions and were included in the analysis. Of 84 participants with age and sex data, 51 (61%) were aged 65 years or older and 45 (54%) were female. Of 85 respondents, 59 (70%) indicated that their current oral health was worse than before cancer treatment. Most respondents (73 of 85 [86%]) endorsed oral complications from cancer treatment, including xerostomia (66 of 73 [90%]), caries (35 of 73 [48%]), and oral mucositis (29 of 73 [40%]); 64 of 73 respondents (88%) required follow-up dental treatment. Overall, 4 of 28 (14%) before HNC treatment and 17 of 53 (32%) after treatment reported finances as the reason that not all recommended dental care was received. A total of 33 of the 85 respondents (39%) said that their postcancer dental care had caused them financial hardship. Individuals who were less likely to endorse financial hardship were more likely to have greater educational attainment (odds ratio [OR], 0.20; 95% CI, 0.06-0.58), higher income (OR, 0.33; 95% CI, 0.11-0.94), increased pre-HNC dental visit frequency (OR, 0.30; 95% CI, 0.10-0.86), same or better oral health after HNC (OR, 0.13; 95% CI, 0.02-0.50), and lower out-of-pocket dental expenses after HNC (OR, 0.09; 95% CI, 0.03-0.29).
In this survey study, most patients undergoing treatment for HNC required extensive dental treatment throughout cancer treatment; this treatment presented a financial burden for 39% of patients that was a limiting barrier to care. Since most private medical insurers do not reimburse for dental treatment, more comprehensive coverage deserves policy attention.
接受头颈部癌症（HNC）治疗的患者会出现需要大量牙科治疗的口腔并发症。这种治疗通常得不到医疗保险的报销，给患者带来了潜在的经济负担。
描述 HNC 患者的牙科护理需求和相关的成本负担。
设计、地点和参与者：本调查研究包括 2023 年 3 月 23 日至 10 月 27 日期间通过 Qualtrics 对 HNC 联盟（HNCA）成员进行的调查。HNCA 利用其社交媒体和电子邮件列表对调查进行了推广。数据分析于 2023 年 10 月至 2024 年 5 月之间进行。
主要结果是 HNC 患者癌症治疗相关的口腔和牙科并发症、癌症治疗与牙科护理使用的关联以及相关牙科治疗的费用。
在接受调查的 100 人中，85 人（85%）完成了所有必需的问题并被纳入分析。在 84 名有年龄和性别数据的参与者中，51 人（61%）年龄在 65 岁或以上，45 人（54%）为女性。在 85 名受访者中，59 人（70%）表示他们目前的口腔健康状况比癌症治疗前更差。大多数受访者（85 名中的 73 名[86%]）表示他们经历了癌症治疗引起的口腔并发症，包括口干（73 名中的 66 名[90%]）、龋齿（73 名中的 35 名[48%]）和口腔黏膜炎（73 名中的 29 名[40%]）；64 名受访者（73 名中的 88%）需要后续的牙科治疗。总体而言，治疗前有 4 人（14%）和治疗后有 17 人（53%）报告经济状况是他们没有接受所有推荐的牙科护理的原因。85 名受访者中有 33 名（39%）表示他们的癌症后牙科护理给他们带来了经济困难。不太可能有经济困难的人更有可能接受更高的教育程度（比值比[OR]，0.20；95%CI，0.06-0.58）、更高的收入（OR，0.33；95%CI，0.11-0.94）、增加 HNC 治疗前的牙科就诊频率（OR，0.30；95%CI，0.10-0.86）、HNC 后口腔健康状况相同或更好（OR，0.13；95%CI，0.02-0.50）和 HNC 后自付牙科费用较低（OR，0.09；95%CI，0.03-0.29）。
在这项调查研究中，大多数接受 HNC 治疗的患者在整个癌症治疗过程中都需要大量的牙科治疗；这对 39%的患者造成了经济负担，是治疗的限制因素。由于大多数私人医疗保险不报销牙科治疗费用，因此更全面的覆盖范围值得政策关注。
