Kris G. Thomas|Travis Martin|Ang Gao|Chul Soo Ahn|H.-J. Wilhelm|David L. Schwartz
Interruptions of Head and Neck Radiotherapy Across Insured and Indigent Patient Populations
Methodist University Hospital|West Cancer Center|The University of Texas Southwestern Medical Center|Methodist University Hospital|West Cancer Center|The University of Texas Southwestern Medical Center|Methodist University Hospital|West Cancer Center|The University of Texas Southwestern Medical Center|Methodist University Hospital|West Cancer Center|The University of Texas Southwestern Medical Center|Methodist University Hospital|West Cancer Center|The University of Texas Southwestern Medical Center|Methodist University Hospital|West Cancer Center|The University of Texas Southwestern Medical Center
radiotherapy head neck cancer cornerstone care requiring 30 35 days treatment 6 7 weeks diligent patient compliance crucial unplanned treatment interruptions reduce cure rates studied interruption rates private carrierinsured medicareinsured populations versus indigent populations served single academic health systema retrospective cohort study electronic medical billing records performed analyzing treatment interruptions january 2011 december 2014 study included 564 patients head neck cancer prescribed radiotherapy referred clinics run university texas southwestern medical center utsw parkland health hospital system phhs provides indigent care dallas county texasthreehundred sixteen patients 56 treatment break 114 patients missed single session 202 patients missed multiple treatments seventy percent phhs patients treatment delays compared 47 utsw patients p 001 number interrupted days phhs population nearly twice observed utsw patients phhs patients commonly missed treatment nonmedical logistical reasons delay predictive local recurrence p 001 overall survival p 001 compliant patients significant difference local recurrence p 43 overall survival p 27 across referral sites however among noncompliant patients higher likelihood local recurrence phhs cohort p 016 multivariable modeling suggested treatment interruption key driver outcome differences across referral sitessurvival outcomes atrisk population inferior patients insured commercial carriers medicare treatment interruption predicted poor outcome across patients disproportionately experienced atrisk patients results highlight cancer control needs specific disadvantaged communities risk poor treatment compliance