The impact of socioeconomic and geographic factors on access to transoral robotic/endoscopic surgery for early stage oropharyngeal malignancy

Matthew Groysman, Sun K. Yi, Jared R. Robbins, Charles C. Hsu, Ricklie Julian, Julie E. Bauman, Audrey Baker, Steven J. Wang, Shethal Bearelly

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To evaluate the role of social and geographic factors on the likelihood of receiving transoral robotic surgery (TORS) or non-robotic transoral endoscopic surgery treatment in early stage oropharyngeal squamous cell carcinoma (OPSCC). Materials and methods: The National Cancer Database was queried to form a cohort of patients with T1-T2 N0-N1 M0 OPSCC (AJCC v.7) who underwent treatment from 2010 to 2016. Demographics, tumor characteristics, treatment type, social, and geographic factors were all collected. Univariate analysis and multivariate logistic regression were then performed. Results: Among 9267 identified patients, 1774 (19.1%) received transoral robotic surgery (TORS), 1191 (12.9%) received transoral endoscopic surgery, and 6302 (68%) received radiation therapy. We found that lower cancer stage, lower comorbidity burden and HPV- positive status predicted a statistically significant increased likelihood of receiving surgery. Patients who reside in suburban or small urban areas (>1 million population), were low-to- middle income, or rely on Medicaid were less likely to receive surgery. Patients that reside in Medicaid-expansion states were more likely to receive TORS (p > .0001). Patients that reside in states that expanded Medicaid January 2014 and after were more likely to receive non-robotic transoral endoscopic surgery (p > .0001). Conclusions: Poorer baseline health, lower socioeconomic status and residence in small urban areas may act as barriers to accessing minimally invasive transoral surgery while residence in a Medicaid-expansion state may improve access. Barriers to accessing robotic surgery may be greater than accessing non-robotic surgery.

Original languageEnglish (US)
Article number103243
JournalAmerican Journal of Otolaryngology - Head and Neck Medicine and Surgery
Volume43
Issue number1
DOIs
StatePublished - Jan 1 2022

Keywords

  • Access to care
  • Oropharyngeal carcinoma
  • TORS
  • Transoral endoscopic surgery
  • Transoral robotic surgery

ASJC Scopus subject areas

  • Otorhinolaryngology

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