Association of significant financial burden with survival for head and neck cancer patients treated with radiation therapy

Sung Jun Ma; Austin J Iovoli; Kristopher Attwood; Kimberly E Wooten; Hassan Arshad; Vishal Gupta; Ryan P McSpadden; Moni A Kuriakose; Michael R Markiewicz; Jon M Chan; Wesley L Hicks; Mary E Platek; Andrew D Ray; Elizabeth A Repasky; Mark K Farrugia; Anurag K Singh

doi:10.1016/j.oraloncology.2021.105196

Association of significant financial burden with survival for head and neck cancer patients treated with radiation therapy

Oral Oncol. 2021 Apr:115:105196. doi: 10.1016/j.oraloncology.2021.105196. Epub 2021 Feb 10.

Authors

Sung Jun Ma¹, Austin J Iovoli², Kristopher Attwood³, Kimberly E Wooten⁴, Hassan Arshad⁵, Vishal Gupta⁶, Ryan P McSpadden⁷, Moni A Kuriakose⁸, Michael R Markiewicz⁹, Jon M Chan¹⁰, Wesley L Hicks¹¹, Mary E Platek¹², Andrew D Ray¹³, Elizabeth A Repasky¹⁴, Mark K Farrugia¹⁵, Anurag K Singh¹⁶

Affiliations

¹ Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 955 Main Street, Buffalo, NY 14203, USA. Electronic address: [email protected].
² Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 955 Main Street, Buffalo, NY 14203, USA. Electronic address: [email protected].
³ Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA. Electronic address: [email protected].
⁴ Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA. Electronic address: [email protected].
⁵ Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA. Electronic address: [email protected].
⁶ Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA. Electronic address: [email protected].
⁷ Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA. Electronic address: [email protected].
⁸ Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA. Electronic address: [email protected].
⁹ Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University at Buffalo, The State University of New York, 3435 Main Street, Buffalo, NY 14214, USA; Department of Neurosurgery, Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 955 Main Street, Buffalo, NY 14203, USA. Electronic address: [email protected].
¹⁰ Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA. Electronic address: [email protected].
¹¹ Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA. Electronic address: [email protected].
¹² Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; Department of Dietetics, D'Youville College, 270 Porter Avenue, Buffalo, NY 14201, USA. Electronic address: [email protected].
¹³ Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA. Electronic address: [email protected].
¹⁴ Department of Immunology, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA. Electronic address: [email protected].
¹⁵ Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA. Electronic address: [email protected].
¹⁶ Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA. Electronic address: [email protected].

Abstract

Objective: To assess the association between financial toxicity and survival in patients with head and neck cancer (HNC).

Materials and methods: Using a single-institution database, we retrospectively reviewed HNC patients treated at Roswell Park Comprehensive Cancer Center treated with definitive or postoperative radiation therapy between 2013 and 2017. Kaplan-Meier method and log-rank tests were used to analyze survival outcomes. Propensity score matching on all clinically relevant baseline characteristics was performed to address selection bias. All statistical tests were two-sided and those less than 0.05 were considered statistically significant.

Results: Of a total of 284 HNC patients (age: median 61 years, IQR 55-67; 220 [77.5%] men), 204 patients (71.8%) received definitive radiation and 80 patients (28.2%) received adjuvant radiation. There were 41 patients (14.4%) who reported high baseline financial toxicity. Chemotherapy was used in 237 patients (83.5%). On multivariable analysis, those with high financial toxicity exhibited worse overall survival (hazards ratio [HR] 1.75, 95% confidence interval [CI] 1.05-2.94, p = 0.03) and cancer specific survival (HR 2.28, 95% CI 1.31-3.96, p = 0.003). On matched pair analysis of 66 patients, high financial toxicity remained associated with worse OS (HR 2.72, 95% CI 1.04-7.09, p = 0.04) and CSS (HR 3.75, 95% CI 1.22-11.5, p = 0.02).

Conclusion: HNC patient reported baseline financial toxicity was significantly correlated with both decreased overall and cancer specific survival. These significant correlations held after match pairing. Further research is warranted to investigate the impact of financial toxicity in HNC and mitigate its risk.

Keywords: Financial support; Head and neck neoplasms; Kaplan-Meier Analysis; Matched-pair analysis; Oral cancer; Survival.

MeSH terms

Cost of Illness*
Female
Head and Neck Neoplasms / economics*
Head and Neck Neoplasms / radiotherapy
Humans
Male
Middle Aged
Radiotherapy, Adjuvant / methods*
Retrospective Studies

Grants and funding

P30 CA016056/CA/NCI NIH HHS/United States