Evaluation of Patient-Reported Delays and Affordability-Related Barriers to Care in Head and Neck Cancer

Objective: To examine the prevalence and predictors of patient-reported barriers to care among survivors of head and neck squamous cell carcinoma and the association with health-related quality of life (HRQOL) outcomes. Study Design: Retrospective cohort study. Setting: Outpatient oncology clinic at an academic tertiary care center. Methods: Data were obtained from the UNC Health Registry/Cancer Survivorship Cohort. Barriers to care included self-reported delays in care and inability to obtain needed care due to cost. HRQOL was measured with validated questionnaires: general (PROMIS) and cancer specific (FACT-GP). Results: The sample included 202 patients with head and neck squamous cell carcinoma with a mean age of 59.6 years (SD, 10.0). Eighty-two percent were male and 87% were White. Sixty-two patients (31%) reported at least 1 barrier to care. Significant predictors of a barrier to care in unadjusted analysis included age ≤60 years (P =.007), female sex (P =.020), being unmarried (P =.016), being uninsured (P =.047), and Medicaid insurance (P =.022). Patients reporting barriers to care had significantly worse physical and mental HRQOL on the PROMIS questionnaires (P <.001 and P =.002, respectively) and lower cancer-specific HRQOL on the FACT-GP questionnaire (P <.001), which persisted across physical, social, emotional, and functional domains. There was no difference in 5-year OS (75.3% vs 84.1%, P =.177) or 5-year CSS (81.6% vs 85.4%, P =.542) in patients with and without barriers to care. Conclusion: Delay- and affordability-related barriers are common among survivors of head and neck cancer and appear to be associated with significantly worse HRQOL outcomes. Certain sociodemographic groups appear to be more at risk of patient-reported barriers to care.