Deemed the “Medicare” effect, patients aged 65 years who have Medicare coverage had an increased incidence of head and neck squamous cell carcinoma (HNSCC) but were less likely to receive a late-stage diagnosis and had lower mortality rates.
Patients of Medicare age have favorable outcomes when it comes to head and neck cancer, say new study findings published in Head & Neck. The researchers of the study write that their findings suggest many patients are waiting to seek cancer diagnosis or treatment until becoming eligible for Medicare.
Deemed the “Medicare” effect, patients aged 65 years who had Medicare coverage had an increased incidence of head and neck squamous cell carcinoma (HNSCC) but were less likely to receive a late-stage diagnosis and had lower mortality rates compared with their slightly younger counterparts on Medicaid or who were uninsured.
“Cumulatively, this suggests a backlog of undiagnosed head and neck cancers within the near-elderly population, which take advantage of their new Medicare benefits to be diagnosed at early stage, treated with more surgery, and go onto to have better survival,” explained the researchers. “Prior studies have demonstrated an increase in the utilization of basic medical services, including cancer screenings and general exams, after patients become eligible for Medicare.”
HNSCC accounts for approximately 3% of new cancer diagnoses in the United States each year and is generally diagnosed in patients aged 60 to 70 years. With cases often found during routine physicals or after experiencing symptoms such as dysphagia or voice changes, the researchers highlighted the importance of access to both primary care doctors and specialists.
Drawing on data from the Surveillance, Epidemiology, and End Results (SEER) database, the researchers found that patients aged 65 years had an HNSCC incidence rate of 46.9 per 100,000 people compared with 41.2 per 100,000 among patients aged 60 to 64 years. Throughout the study period, nearly 58,000 patients in the SEER database were diagnosed with HSNCC. The researchers noted that their study assumed patients with HSNCC at 60 to 64 years were similar to patients aged 65 years except for Medicare eligibility.
Compared with patients aged 60 to 64 who were either on Medicaid or uninsured, those aged 65 years were less likely to receive a later-stage diagnosis. The slightly younger patients on Medicaid or who were uninsured were 16% and 19% more likely to get a later-stage HNSCC diagnosis, respectively.
Similar findings were seen among mortality rates, with patients on Medicaid and those who were uninsured having a 44% and 39% increased risk of cancer-specific mortality (CSM), respectively. The lower mortality rate observed among patients with Medicare may have resulted from the earlier diagnosis, as well as their increased likelihood of receiving cancer-specific surgery.
“The earlier stage disease and decreased CSM among Medicare-eligible patients further suggests access to adequate insurance under the Medicare program plays a large role in providing timely cancer care and improving survival outcomes in those 65 and older,” commented the researchers. “This finding is consistent with prior studies which have found patients with cancers across various anatomic sites, including the head and neck, present with more advanced disease when uninsured.”
Notably, patients aged 60 to 64 who were commercially insured had a 19% decreased risk of CSM compared with patients aged 65 years.
Smith J, Jayanth P, Hong S, Simpson M, Massa S. The “Medicare effect” on head and neck cancer diagnosis and survival. Head Neck. Published online April 25, 2023. doi:10.1002/hed.27379