Education and insurance status: Impact on treatment and survival of sinonasal cancer patients

Objectives/Hypothesis To understand the impact of education and insurance as social determinants of health on sinonasal cancer treatment and outcomes. Study Design Retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER) database. Methods Demographics, tumor characteristics, location, stage at diagnosis, treatment, and survival data for 1,365 patients diagnosed with sinonasal cancers were extracted from the SEER database. All statistical analyses were performed using SAS 9.5. The Fine and Grey method was used to assess covariate impacts. Results Medicaid patients were more likely to live in counties with lower educational levels (8.32% vs. 6.46% below ninth grade education, P < .0001) and lower median household incomes ($56,316 vs. $60,284, P = .0004). Medicaid patients presented with later (T3-T4) stage disease compared to other insurances (P = .0007) and larger tumor size (P = .011). Medicaid patients were less likely to have surgery recommended (P = .0017) or receive surgery as part of their treatment (P = .0033). Analysis of histology-specific 5-year survival rates were lower for Medicaid patients with squamous cell carcinoma (SCCA) (P = .016). Conclusions This is the first and largest study to examine how education and insurance status may impact treatment and outcomes in sinonasal cancers. It is the first using this method of examining other covariates and informing associated risk. Patients with Medicaid and less education present with larger sinonasal cancers. They are less likely to have surgery recommended or receive surgery. For SCCA, the most common histology, Medicaid patients have significantly worse survival. Further emphasis on education and improving health literacy is needed in the at-risk Medicaid populations. Level of Evidence NA Laryngoscope, 130:649-658, 2020