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Greater Financial Burden Seen for Head and Neck Ca Patients

Patients with head and neck cancer (HNC) are at a distinct financial disadvantage compared with patients with other types of cancer, according to a recent study.

Specifically, patients with HNC incurred $2,400 more in annual medical expenses and spent a greater percentage of their income on out-of-pocket expenses, reported Sean Massa, MD, of Washington University in St. Louis, and colleagues.

The highest relative out-of-pocket costs occurred among poor patients and those who were publicly insured.

"For patients with HNC, limited resources and higher expenses manifest as higher mean out-of-pocket expenses as a percentage of their income," the authors wrote in JAMA Otolaryngology-Head & Neck Surgery. "In some cases, out-of-pocket medical expenses consume all of a household's income for a given year."

Massa and colleagues reviewed data on 16,771 patients with cancer from the Medical Expenditure Panel Survey from 1998 to 2015. Of these, 489 patients were diagnosed with HNC.

Patients diagnosed with HNC were more commonly of a minority race/ethnicity, male, poor, publicly insured, and had less education, with a lower general and mental health status.

Each year, patients with HNC spent a median of $8,384 on medical expenses compared with a median of $5,978 for patients with other types of cancer (difference of $2,406). This total expense amount included expenses reported by the household of each patient and practitioner survey components.

Interestingly, Asian patients had almost half the annual expenses compared with whites ($5,359 vs $10,078). Patients from the Northwest had greater annual expenses ($10,549) compared with Westerners ($8,094) and Midwesterners ($5,656). Finally, there was a $10,000 difference in annual median medical expenses for patients with better health status compared with those with poor health status ($6,714 vs $16,990).

The relative out-of-pocket expenses were similar, but still higher, for patients with HNC compared with other cancer types (3.93% vs 3.07%). These differences "appear to be explained primarily by the differences in income," according to the researchers.

Patients with higher total income and higher income rating on the poverty index had lower relative expenses. Those patients with public insurance had higher relative out-of-pocket expenses compared with privately insured patients (5.35% vs 2.87%); as did poor patients (13.07% vs 2.06% for high-income patients), and those with lower health status (10.2% vs 1.58% for those with excellent health).

In an accompanying editorial, Daniel Deschler, MD, of Massachusetts Eye and Ear Infirmary in Boston, pointed out that although the study was strong, it only included information on about 500 patients with head and neck cancer; more information is needed.

"We cannot immediately alter the patient demographics associated with disproportionate financial burdens for patients with HNC," Deschler wrote. "Poverty, bias, lack of education, and impaired physical and mental health are society's great challenges, but we can be alert for those individuals at risk in our world."

To begin to collect data and combat the problem, Deschler suggested harnessing the power of big data.

"Now that we have unleashed the leviathan of the electronic medical record, which so dominates all aspects of our clinical and expanding clerical care, we need to harness the vast information potentially accessible with this technological beast for the benefits of the survivor of HNC," Deschler wrote. "If an electronic medical record can assess our adherence with a meaningful use initiative, perhaps we can meaningfully use that same electronic medical record to identify resources to lessen the economic burden for our patients."

Massa and Deschler reported having no conflicts of interest.

Source: https://www.medpagetoday.com/hematologyoncology/othercancers/78151

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