Affiliation:
1. Department of Otolaryngology Head and Neck Surgery Icahn School of Medicine at Mount Sina New York New York USA
Abstract
ObjectivesThe objective of this study was to compare treatment characteristics and outcomes between patients with HPV‐positive oropharyngeal squamous cell carcinoma (OPSCC) treated at hospitals of varying safety‐net burden status.MethodsPatients with cT1‐4, N0‐3, M0 HPV‐positive OPSCC who underwent definitive surgery or radiation were included. Patients were grouped based on their treating hospital safety‐net burden status, defined as the percentage of uninsured and Medicaid‐insured patients with OPSCC treated at the facility and stratified as low burden (LBH: 0–25th percentile), medium burden (MBH: 25th–75th percentile), or high burden (HBH: 75th–100th percentile). The primary outcome was primary treatment with surgery versus radiation, evaluated with multivariable‐adjusted logistic regression. Secondary outcomes included TORS versus open surgical approach, and overall survival evaluated with Cox proportional hazards analysis.ResultsOf the 19,810 patients with cT1‐4, N0‐3, M0 HPV‐positive OPSCC included in this study, 4921 (24.8%) were treated at LBH, 12,201 (61.6%) were treated at MBH, and 2688 (13.6%) were treated at HBH. In multivariable‐adjusted analysis, compared with treatment at LBH, treatment at HBH was associated with more frequent radiation over surgical treatment (OR: 1.26, 95% CI: 1.12–1.40, p < 0.001). For patients undergoing surgery, patients at HBH had less frequent transoral robotic surgery (OR: 0.30, 95% CI 0.24–0.38, p < 0.001) compared with patients treated at LBH. Overall survival of patients treated at HBH was worse than that of patients treated at LBH (HR: 1.27, 95% CI 1.13–1.43, p < 0.001).ConclusionThese findings highlight underlying disparities at higher safety‐net burden facilities that impact patterns of care and outcomes for patients with OPSCC.Level of Evidence3 Laryngoscope, 2023