(105) Association Between Uninsurance and Receipt of Palliative Radiotherapy in Head and Neck Cancer Patients

Introduction: Social determinants of health (SDOH) influence community health and may affect whether radiotherapy (RT) is delivered with curative or palliative intent in head and neck cancer (HNC). The relative contributions of insurance coverage and social barriers to RT intent in HNC remains unclear.

Methods: This cross-sectional study examined patients treated with RT for HNC within the University of Colorado Health system. Patients with indeterminate or missing RT intent, SVI, DCI, or insurance data were excluded. Groups were established based on RT intent, which was dichotomized as palliative versus curative. Baseline comparisons were performed using Fisher’s exact test and Mann-Whitney U tests. Multivariate logistic regression assessed associations between social determinants (including SVI, DCI, and insurance status) and receipt of palliative RT, controlling for suspected covariates and covariates identified in bivariate analysis.

Results: Of 845 patients, 81 (9.6%) received palliative RT and 764 (90.4%) received curative RT. Palliative RT patients were older (median 71 vs. 64 years, p < 0.001) and differed by race (p = 0.03) and insurance status (p = 0.02). Specifically, the palliative RT group was comprised of more American Indian or Alaska Native (3.7% vs 0.1%) and uninsured patients (6.2% vs 2.0%). Median SVI and DCI scores did not differ between treatment groups. In multivariate analysis, older age (OR 1.04, 95% CI 1.02–1.06, p < 0.001) and uninsured status (OR 4.06, 95% CI 1.09–13.45, p = 0.027) were independently associated with higher odds of receiving palliative RT, though SVI (OR 1.01, 95% CI 0.998-1.02, p = 0.09) and DCI (OR 0.99, 95% CI 0.98-1.00, p = 0.15) did not show an association. Racial categories, though different in chi-square testing, demonstrated no differences in multivariate regression.

Conclusions: These findings suggest that lack of insurance coverage represents a more immediate and actionable barrier to curative treatment than disadvantages at the community level, highlighting insurance access as a critical target for interventions aimed at reducing inequity in HNC care.