INTRODUCTION
Head and neck cancers (HNCA) account for 4% of all newly diagnosed cancers each year in the United States.1 Squamous cell carcinoma of the oral cavity (OCSCC) and oropharynx comprise the majority of HNCA, with a combined incidence of 3% per year.2 For OCSCC, surgery is generally understood to provide superior oncologic outcomes compared to the primary treatment modalities of radiotherapy and/or chemotherapy. Underscoring this, the National Comprehensive Cancer Network (NCCN) guidelines recommend primary surgery as the first-line treatment modality for OCSCC of all stages (I-IVA), often followed by adjuvant radiation with or without chemotherapy.3 Non-curative treatment options that do not include surgery are reserved for cases of unresectable disease (stage IVB).
Previous studies have shown that for several different cancer populations in the United States, insurance status impacts cancer stage at initial presentation, with uninsured or publicly insured (Medicare, Medicaid) patients presenting with more advanced cancers than privately insured patients.4-7 Subsequently, cancer patients who are uninsured have significantly decreased survival outcomes when compared to patients with private insurance.8 This disparity is most likely multifactorial; however, it is known that insurance type is strongly associated with the odds of receiving definitive treatment with curative intent.9 This disparity in cancer care and survival is likely even more pronounced for those with advanced stages of disease. To our knowledge, the association between insurance status (including Medicaid coverage), and receipt of definitive treatment has yet to be investigated for patients with OCSCC.
This information is important to help guide public health initiatives that seek to reform access to cancer care, and to assist those with less financial means. The 2010 Patient Protection and Affordable Care Act (ACA) was designed to expand access to healthcare, largely through Medicaid expansion. It has assisted millions of individuals with incomes near the national poverty levels to gain health insurance. However, its impact on extending oncologic care for patients with OCSCC has yet to be rigorously investigated.