The following is a summary of “Quantifying Total and Out-of-Pocket Costs Associated With Head and Neck Cancer Survivorship” published in the October 2022 issue of Otolaryngol Head Neck Surgery by Massa et al.


Head and neck cancer (HNC) patients have high treatment costs, but they also have extensive post-treatment care requirements. Due to their increasing numbers, HNC survivors necessitate special care. Treatment-related morbidity is a common problem for this group of cancer survivors. To identify risk variables for financial toxicity among HNC survivors and to describe the total and out-of-pocket (OOP) costs associated with HNC survival. An economic analysis and retrospective examination of HNC patients in the United States from 2006-2018. Information from International Business Machines (IBM’s) MarketScan Commercial Claims Database was used for the analysis. From the end of 2020 to the end of 2022, data were analyzed.

HNC Treatment Based on Exposures. Monthly assessments of total and out-of-pocket medical costs were recorded in relation to the date of HNC diagnosis. The primary outcome measure was the change from baseline in a patient’s mean monthly survivor costs (13-60 months post-diagnosis) (7-12 months before diagnosis). For overall and out-of-pocket expenditures, univariate and multivariate linear regression models were developed to estimate coefficients with 95% CIs. There were a total of 19,098 patients with HNC included in this cost-effectiveness analysis (median [range] age, 56 [18-64] years; 14 144 [74.1%] men and 4,954 [25.0%] women; race and ethnicity were not factors). Total and out-of-pocket costs during the survivorship period were $372 and $31 more than the baseline, respectively, albeit these figures varied widely according to patient demographics, insurance coverage, and oncologic factors. Multivariate analysis found that females had higher out-of-pocket (OOP) and total (95% CI: $126 to $560) excess survival expenses. Oral cavity cancers had the lowest excess survivorship costs ($703/mo; 95% CI, $967 to $439) compared to other cancer sites. 

Total excess survivorship costs were highest for hypopharyngeal ($1,908/mo; 95% CI, $1,102 to $2,714) and lowest for oropharyngeal ($1,908/mo; 95% CI, $967 to $2,714) cancers. In most cases, multimodal treatment resulted in higher out-of-pocket (OOP) survival expenditures than surgery or radiation therapy alone. Expenses associated with HNC survivability are found to be consistently higher than baseline costs for at least 5 years after diagnosis. Female gender, hypopharyngeal tumors, and multimodal therapy resulted in high survivability costs. Medical professionals owe it to their patients who are at a greater risk of financial toxicity as a result of treatment, to do everything in their power to keep those bills as low as possible while also providing them with focused emotional support.

Source: jamanetwork.com/journals/jamaotolaryngology/article-abstract/2797523