Comparison of the Financial Burden of Survivors of Head and Neck Cancer with Other Cancer Survivors

Sean T. Massa, Nosayaba Osazuwa-Peters, Eric Adjei Boakye, Ronald J. Walker, Gregory M. Ward

Research output: Contribution to journalArticlepeer-review

82 Scopus citations


Importance: Head and neck cancer (HNC) is more common among socioeconomically disenfranchised individuals, making financial burden particularly relevant. Objective: To assess the financial burdens of HNC compared with other cancers. Design, Setting, and Participants: In this retrospective review of nationally representative, publicly available survey, data from the Medical Expenditure Panel Survey were extracted from January 1, 1998, to December 31, 2015. A total of 444867 adults were surveyed, which extrapolates to a population of 221503108 based on the weighted survey design. Data analysis was performed from April 18, 2018, to August 20, 2018. Exposures: Of 16771 patients with cancer surveyed (weighted count of 10083586 patients), 489 reported HNC (weighted count of 261631). Main Outcomes and Measures: Patients with HNC were compared with patients with other cancers on demographics, income, employment, and health. Within the HNC group, risk factors for total medical expenses and relative out-of-pocket expenses were assessed with regression modeling. Complex sampling methods were accounted for with weighting using balanced repeated replication. Results: A total of 16771 patients (mean [SD] age, 62.3 [18.9] years; 9006 [53.7%] female) with cancer were studied. Compared with patients with other cancers, patients with HNC were more often members of a minority race/ethnicity, male, poor, publicly insured, and less educated, with lower general and mental health status. Median annual medical expenses ($8384 vs $5978; difference, $2406; 95% CI, $795-$4017) and relative out-of-pocket expenses (3.93% vs 3.07%; difference, 0.86%; 95% CI, 0.06%-1.66%) were higher for patients with HNC than for patients with other cancers. Among patients with HNC, median expenses were lower for Asian individuals compared with white individuals ($5359 vs $10078; difference, $4719; 95% CI, $1481-$7956]), Westerners ($8094) and Midwesterners ($5656) compared with Northwesterners ($10549), and those with better health status ($16990 for those with poor health vs $6714 for those with excellent health). Higher relative out-of-pocket expenses were associated with unemployment (5.13% for employed patients vs 2.35% for unemployed patients; difference, 2.78%; 95% CI, 0.6%-4.95%), public insurance (5.35% for those with public insurance vs 2.87% for those with private insurance; difference, 2.48%; 95% CI, -0.6% to 5.55%), poverty (13.07% for poor patients vs 2.06% for high-income patients), and lower health status (10.2% for those with poor health vs 1.58% for those with excellent health). Conclusions and Relevance: According to this study, HNC adds a substantial, additional burden to an already financially strained population in the form of higher total and relative expenses. The financial strain on individuals, assessed as relative out-of-pocket expenses, appears to be driven more by income than by health factors, and health insurance does not appear to be protective.

Original languageEnglish
Pages (from-to)239-249
Number of pages11
JournalJAMA Otolaryngology - Head and Neck Surgery
Issue number3
StatePublished - Mar 1 2019


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