Interruptions of head and neck radiotherapy across insured and indigent patient populations

Kimberly Thomas, Travis Martin, Ang Gao, Chul Ahn, Holly Wilhelm, David Schwartz

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Purpose Radiotherapy for head and neck cancer is a cornerstone of care, requiring 30 to 35 days of treatment over 6 to 7 weeks. Diligent patient compliance is crucial, and unplanned treatment interruptions reduce cure rates. We studied interruption rates in private carrier-insured and Medicare-insured populations versus indigent populations served by a single academic health system. Materials and Methods A retrospective cohort study of electronic medical and billing records was performed analyzing treatment interruptions between January 2011 and December 2014. The study included 564 patientswith head and neck cancer prescribed radiotherapy and referred from clinics run by University of Texas Southwestern Medical Center (UTSW) and the Parkland Health and Hospital System (PHHS), which provides indigent care to Dallas County, Texas. Results Three-hundred sixteen patients (56%) had a treatment break; 114 patients missed a single session, and 202 patients missed multiple treatments. Seventy percent of PHHS patients had treatment delays compared with 47% of UTSW patients (P , .001). The number of interrupted days in thePHHSpopulationwasnearly twice that observed inUTSWpatients. PHHS patients most commonly missed treatment for nonmedical or logistical reasons. Delay was predictive for local recurrence (P , .001) and overall survival (P , .001). In compliant patients, there was no significant difference in local recurrence (P = .43) or overall survival (P = .27) across referral sites. However, among noncompliant patients, there was a higher likelihood for local recurrence in the PHHS cohort (P = .016). Multivariable modeling suggested treatment interruption to be a key driver of outcome differences across referral sites. Conclusion Survival outcomes in our at-risk population were inferior to those in patients insured by commercial carriers or Medicare. Treatment interruption predicted for poor outcome across all patients but was disproportionately experienced by at-risk patients. These results highlight cancer control needs specific to disadvantaged communities at risk for poor treatment compliance.

Original languageEnglish (US)
Pages (from-to)e319-e328
JournalJournal of Oncology Practice
Volume13
Issue number4
DOIs
StatePublished - Apr 1 2017

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Poverty
Neck
Radiotherapy
Head
Population
Health
Therapeutics
Head and Neck Neoplasms
Medicare
Recurrence
Survival
Referral and Consultation
Uncompensated Care
Electronic Health Records
Vulnerable Populations
Patient Compliance
Cohort Studies
Retrospective Studies

All Science Journal Classification (ASJC) codes

  • Oncology
  • Oncology(nursing)
  • Health Policy

Cite this

Interruptions of head and neck radiotherapy across insured and indigent patient populations. / Thomas, Kimberly; Martin, Travis; Gao, Ang; Ahn, Chul; Wilhelm, Holly; Schwartz, David.

In: Journal of Oncology Practice, Vol. 13, No. 4, 01.04.2017, p. e319-e328.

Research output: Contribution to journalArticle

Thomas, Kimberly ; Martin, Travis ; Gao, Ang ; Ahn, Chul ; Wilhelm, Holly ; Schwartz, David. / Interruptions of head and neck radiotherapy across insured and indigent patient populations. In: Journal of Oncology Practice. 2017 ; Vol. 13, No. 4. pp. e319-e328.
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abstract = "Purpose Radiotherapy for head and neck cancer is a cornerstone of care, requiring 30 to 35 days of treatment over 6 to 7 weeks. Diligent patient compliance is crucial, and unplanned treatment interruptions reduce cure rates. We studied interruption rates in private carrier-insured and Medicare-insured populations versus indigent populations served by a single academic health system. Materials and Methods A retrospective cohort study of electronic medical and billing records was performed analyzing treatment interruptions between January 2011 and December 2014. The study included 564 patientswith head and neck cancer prescribed radiotherapy and referred from clinics run by University of Texas Southwestern Medical Center (UTSW) and the Parkland Health and Hospital System (PHHS), which provides indigent care to Dallas County, Texas. Results Three-hundred sixteen patients (56{\%}) had a treatment break; 114 patients missed a single session, and 202 patients missed multiple treatments. Seventy percent of PHHS patients had treatment delays compared with 47{\%} of UTSW patients (P , .001). The number of interrupted days in thePHHSpopulationwasnearly twice that observed inUTSWpatients. PHHS patients most commonly missed treatment for nonmedical or logistical reasons. Delay was predictive for local recurrence (P , .001) and overall survival (P , .001). In compliant patients, there was no significant difference in local recurrence (P = .43) or overall survival (P = .27) across referral sites. However, among noncompliant patients, there was a higher likelihood for local recurrence in the PHHS cohort (P = .016). Multivariable modeling suggested treatment interruption to be a key driver of outcome differences across referral sites. Conclusion Survival outcomes in our at-risk population were inferior to those in patients insured by commercial carriers or Medicare. Treatment interruption predicted for poor outcome across all patients but was disproportionately experienced by at-risk patients. These results highlight cancer control needs specific to disadvantaged communities at risk for poor treatment compliance.",
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N2 - Purpose Radiotherapy for head and neck cancer is a cornerstone of care, requiring 30 to 35 days of treatment over 6 to 7 weeks. Diligent patient compliance is crucial, and unplanned treatment interruptions reduce cure rates. We studied interruption rates in private carrier-insured and Medicare-insured populations versus indigent populations served by a single academic health system. Materials and Methods A retrospective cohort study of electronic medical and billing records was performed analyzing treatment interruptions between January 2011 and December 2014. The study included 564 patientswith head and neck cancer prescribed radiotherapy and referred from clinics run by University of Texas Southwestern Medical Center (UTSW) and the Parkland Health and Hospital System (PHHS), which provides indigent care to Dallas County, Texas. Results Three-hundred sixteen patients (56%) had a treatment break; 114 patients missed a single session, and 202 patients missed multiple treatments. Seventy percent of PHHS patients had treatment delays compared with 47% of UTSW patients (P , .001). The number of interrupted days in thePHHSpopulationwasnearly twice that observed inUTSWpatients. PHHS patients most commonly missed treatment for nonmedical or logistical reasons. Delay was predictive for local recurrence (P , .001) and overall survival (P , .001). In compliant patients, there was no significant difference in local recurrence (P = .43) or overall survival (P = .27) across referral sites. However, among noncompliant patients, there was a higher likelihood for local recurrence in the PHHS cohort (P = .016). Multivariable modeling suggested treatment interruption to be a key driver of outcome differences across referral sites. Conclusion Survival outcomes in our at-risk population were inferior to those in patients insured by commercial carriers or Medicare. Treatment interruption predicted for poor outcome across all patients but was disproportionately experienced by at-risk patients. These results highlight cancer control needs specific to disadvantaged communities at risk for poor treatment compliance.

AB - Purpose Radiotherapy for head and neck cancer is a cornerstone of care, requiring 30 to 35 days of treatment over 6 to 7 weeks. Diligent patient compliance is crucial, and unplanned treatment interruptions reduce cure rates. We studied interruption rates in private carrier-insured and Medicare-insured populations versus indigent populations served by a single academic health system. Materials and Methods A retrospective cohort study of electronic medical and billing records was performed analyzing treatment interruptions between January 2011 and December 2014. The study included 564 patientswith head and neck cancer prescribed radiotherapy and referred from clinics run by University of Texas Southwestern Medical Center (UTSW) and the Parkland Health and Hospital System (PHHS), which provides indigent care to Dallas County, Texas. Results Three-hundred sixteen patients (56%) had a treatment break; 114 patients missed a single session, and 202 patients missed multiple treatments. Seventy percent of PHHS patients had treatment delays compared with 47% of UTSW patients (P , .001). The number of interrupted days in thePHHSpopulationwasnearly twice that observed inUTSWpatients. PHHS patients most commonly missed treatment for nonmedical or logistical reasons. Delay was predictive for local recurrence (P , .001) and overall survival (P , .001). In compliant patients, there was no significant difference in local recurrence (P = .43) or overall survival (P = .27) across referral sites. However, among noncompliant patients, there was a higher likelihood for local recurrence in the PHHS cohort (P = .016). Multivariable modeling suggested treatment interruption to be a key driver of outcome differences across referral sites. Conclusion Survival outcomes in our at-risk population were inferior to those in patients insured by commercial carriers or Medicare. Treatment interruption predicted for poor outcome across all patients but was disproportionately experienced by at-risk patients. These results highlight cancer control needs specific to disadvantaged communities at risk for poor treatment compliance.

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