Mono-institutional retrospective cohort analysis of the insurance status dependent access to ENT-professionals and survival in head and neck squamous cell carcinoma

BackgroundTo access the influence of insurance status on time of diagnosis, quality of treatment and survival in head and neck squamous cell carcinoma (HNSCC).MethodsThis mono-institutional retrospective cohort analysis included all HNSCC patients (n=1,054) treated between 2001 and 2011, and subdivided the cohort according to the insurance status. Differences between the groups were analyzed using the Chi square and the unpaired student's t-test. Survival rates were calculated by Kaplan-Meier and Cox regression for forward selection.ResultsNine hundred twenty-five patients showed general, 129 private insurance. The 2 groups were equal regarding age, gender, tumor localization, therapy, and N/M/G/R-status. The T-status differed significantly between the groups showing more advanced tumors in patients with general insurance (p=0.002). While recurrence-free survival was comparable in both groups, overall survival was significantly better in private patients (p=0.009). The time frame between first symptom and diagnosis was equal in both groups.ConclusionsThe time frame between subjective percipience of first symptom and final therapy did not differ between the groups. In our cohort, access to otorhinolaryngological specialists is favorable in both, patients with general and private insurance. Recurrence-free survival was comparable in both groups, indicating successful HNSCC treatment both groups. However, overall survival was significantly better in patients with private insurance suggesting other socioeconomic factors influencing survival.

Automated summary

This study found that insurance status did not significantly impact the time of diagnosis, quality of treatment, and survival in HNSCC patients. There were no differences in age, gender, tumor localization, and therapy between patients with general insurance and private insurance, but overall survival was better in patients with private insurance.