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

TitleThe impact of socioeconomic and geographic factors on access to transoral robotic/endoscopic surgery for early stage oropharyngeal malignancy.
Publication TypeJournal Article
Year of Publication2022
AuthorsGroysman M, Yi SK, Robbins JR, Hsu CC, Julian R, Bauman JE, Baker A, Wang SJ, Bearelly S
JournalAm J Otolaryngol
Volume43
Issue1
Pagination103243
Date Published2022 Jan-Feb
ISSN1532-818X
KeywordsAged, Databases, Factual, Female, Geography, Health Services Accessibility, Humans, Male, Middle Aged, Natural Orifice Endoscopic Surgery, Neoplasm Staging, Oropharyngeal Neoplasms, Retrospective Studies, Robotic Surgical Procedures, Socioeconomic Factors, Squamous Cell Carcinoma of Head and Neck, United States
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.

DOI10.1016/j.amjoto.2021.103243
Alternate JournalAm J Otolaryngol
PubMed ID34583290
Faculty Reference: 
Audrey Baker, MD
Shethal Bearelly, MD, FACS
Steven J. Wang, MD