Evaluation of Patient-Reported Delays and Affordability-Related Barriers to Care in Head and Neck Cancer
Objective To examine the prevalence and predictors of patient-reported barriers to care among survivors of head and neck squamous cell carcinoma and the association with health-related quality of life (HRQOL) outcomes. Study Design Retrospective cohort study. Setting Outpatient oncology clinic at an...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-12-01
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| Series: | OTO Open |
| Online Access: | https://doi.org/10.1177/2473974X211065358 |
| _version_ | 1797669290234609664 |
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| author | Nicholas R. Lenze MD, MPH Jeannette T. Bensen MS, PhD Laura Farnan PhD Siddharth Sheth DO, MPH Jose P. Zevallos MD, MPH Wendell G. Yarbrough MD, MMHC Adam M. Zanation MD |
| author_facet | Nicholas R. Lenze MD, MPH Jeannette T. Bensen MS, PhD Laura Farnan PhD Siddharth Sheth DO, MPH Jose P. Zevallos MD, MPH Wendell G. Yarbrough MD, MMHC Adam M. Zanation MD |
| author_sort | Nicholas R. Lenze MD, MPH |
| collection | DOAJ |
| description | Objective To examine the prevalence and predictors of patient-reported barriers to care among survivors of head and neck squamous cell carcinoma and the association with health-related quality of life (HRQOL) outcomes. Study Design Retrospective cohort study. Setting Outpatient oncology clinic at an academic tertiary care center. Methods Data were obtained from the UNC Health Registry/Cancer Survivorship Cohort. Barriers to care included self-reported delays in care and inability to obtain needed care due to cost. HRQOL was measured with validated questionnaires: general (PROMIS) and cancer specific (FACT-GP). Results The sample included 202 patients with head and neck squamous cell carcinoma with a mean age of 59.6 years (SD, 10.0). Eighty-two percent were male and 87% were White. Sixty-two patients (31%) reported at least 1 barrier to care. Significant predictors of a barrier to care in unadjusted analysis included age ≤60 years ( P = .007), female sex ( P = .020), being unmarried ( P = .016), being uninsured ( P = .047), and Medicaid insurance ( P = .022). Patients reporting barriers to care had significantly worse physical and mental HRQOL on the PROMIS questionnaires ( P < .001 and P = .002, respectively) and lower cancer-specific HRQOL on the FACT-GP questionnaire ( P < .001), which persisted across physical, social, emotional, and functional domains. There was no difference in 5-year OS (75.3% vs 84.1%, P = .177) or 5-year CSS (81.6% vs 85.4%, P = .542) in patients with and without barriers to care. Conclusion Delay- and affordability-related barriers are common among survivors of head and neck cancer and appear to be associated with significantly worse HRQOL outcomes. Certain sociodemographic groups appear to be more at risk of patient-reported barriers to care. |
| first_indexed | 2024-03-11T20:42:05Z |
| format | Article |
| id | doaj.art-1b6e4eb133ef4989a07502ddd7c19b74 |
| institution | Directory Open Access Journal |
| issn | 2473-974X |
| language | English |
| last_indexed | 2024-03-11T20:42:05Z |
| publishDate | 2021-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | OTO Open |
| spelling | doaj.art-1b6e4eb133ef4989a07502ddd7c19b742023-10-02T01:19:08ZengWileyOTO Open2473-974X2021-12-01510.1177/2473974X211065358Evaluation of Patient-Reported Delays and Affordability-Related Barriers to Care in Head and Neck CancerNicholas R. Lenze MD, MPH0Jeannette T. Bensen MS, PhD1Laura Farnan PhD2Siddharth Sheth DO, MPH3Jose P. Zevallos MD, MPH4Wendell G. Yarbrough MD, MMHC5Adam M. Zanation MD6Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USADepartment of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USALineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USADivision of Hematology and Oncology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USADepartment of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USADepartment of Pathology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USADepartment of Otolaryngology–Head and Neck Surgery, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USAObjective To examine the prevalence and predictors of patient-reported barriers to care among survivors of head and neck squamous cell carcinoma and the association with health-related quality of life (HRQOL) outcomes. Study Design Retrospective cohort study. Setting Outpatient oncology clinic at an academic tertiary care center. Methods Data were obtained from the UNC Health Registry/Cancer Survivorship Cohort. Barriers to care included self-reported delays in care and inability to obtain needed care due to cost. HRQOL was measured with validated questionnaires: general (PROMIS) and cancer specific (FACT-GP). Results The sample included 202 patients with head and neck squamous cell carcinoma with a mean age of 59.6 years (SD, 10.0). Eighty-two percent were male and 87% were White. Sixty-two patients (31%) reported at least 1 barrier to care. Significant predictors of a barrier to care in unadjusted analysis included age ≤60 years ( P = .007), female sex ( P = .020), being unmarried ( P = .016), being uninsured ( P = .047), and Medicaid insurance ( P = .022). Patients reporting barriers to care had significantly worse physical and mental HRQOL on the PROMIS questionnaires ( P < .001 and P = .002, respectively) and lower cancer-specific HRQOL on the FACT-GP questionnaire ( P < .001), which persisted across physical, social, emotional, and functional domains. There was no difference in 5-year OS (75.3% vs 84.1%, P = .177) or 5-year CSS (81.6% vs 85.4%, P = .542) in patients with and without barriers to care. Conclusion Delay- and affordability-related barriers are common among survivors of head and neck cancer and appear to be associated with significantly worse HRQOL outcomes. Certain sociodemographic groups appear to be more at risk of patient-reported barriers to care.https://doi.org/10.1177/2473974X211065358 |
| spellingShingle | Nicholas R. Lenze MD, MPH Jeannette T. Bensen MS, PhD Laura Farnan PhD Siddharth Sheth DO, MPH Jose P. Zevallos MD, MPH Wendell G. Yarbrough MD, MMHC Adam M. Zanation MD Evaluation of Patient-Reported Delays and Affordability-Related Barriers to Care in Head and Neck Cancer OTO Open |
| title | Evaluation of Patient-Reported Delays and Affordability-Related Barriers to Care in Head and Neck Cancer |
| title_full | Evaluation of Patient-Reported Delays and Affordability-Related Barriers to Care in Head and Neck Cancer |
| title_fullStr | Evaluation of Patient-Reported Delays and Affordability-Related Barriers to Care in Head and Neck Cancer |
| title_full_unstemmed | Evaluation of Patient-Reported Delays and Affordability-Related Barriers to Care in Head and Neck Cancer |
| title_short | Evaluation of Patient-Reported Delays and Affordability-Related Barriers to Care in Head and Neck Cancer |
| title_sort | evaluation of patient reported delays and affordability related barriers to care in head and neck cancer |
| url | https://doi.org/10.1177/2473974X211065358 |
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