Adolescent and young adult (AYA) head and neck cancer (HNC) patients require longer term follow-ups as they age; yet, little is known about factors associated with survivorship in this population. We aimed to describe nonclinical factors associated with HNC survivorship among AYAs.
Methods:
In this retrospective cohort study, the Surveillance, Epidemiology and End Results 18 database from 2007 to 2014 was queried. Eligible cases were 15–39-year-old primary HNC patients with known cause of death (n = 1777). Kaplan–Meier survival curves stratified by age group (15–29, 30–34, and 35–39) and by health insurance status tested differences in HNC survival among groups with a log-rank test. Variables, including age, sex, race/ethnicity, county-level poverty, anatomic site, stage, and treatment, were controlled for in a competing risk proportional hazards model.
Results:
Patients were mostly male (64%), with mean age of 33.4 years. Survival rate was 73% after 8 years of follow-up. There were no significant survival differences based on age at diagnosis. However, AYAs who were on Medicaid (adjusted hazard ratio [aHR] = 1.61, 95% confidence interval [CI] 1.22–2.12) or uninsured (aHR = 1.51, 95% CI 1.03–2.21), had an increased hazard of death from HNC, compared with those with private insurance.
Conclusion:
Health insurance status is the main nonclinical factor associated with survival among AYAs with HNC, and individuals with Medicaid do not fare better than the uninsured. With a potential longer term follow-up in this AYA population, there is need to optimize survivorship irrespective of health insurance status.
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