Cancer Survivors: Insurance Patterns Before and After Affordable Care Act Interview with:

Nina Niu Sanford, M.D. Assistant ProfessorUT Southwestern Department of Radiation OncologyDallas TX 75390

Dr. Sanford

Nina Niu Sanford, M.D. 
Assistant Professor
UT Southwestern Department of Radiation Oncology
Dallas TX 75390 What is the background for this study? What are the main findings?

Response: The background for this study is that we know cancer survivors are at risk for uninsurance or underinsurance and the most commonly cited reason for this is cost of insurance.  However, there have been no prior studies assessing from the patient perspective the reasons for not having insurance.

In addition, there has been further recent controversy over the Affordable Care Act, including threats from the current administration to dismantle it.  Thus assessing the impact of the ACA among at risk populations including cancer survivors is timely.

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Factor in Quality of Life When Deciding Radiotherapy vs Surgery in Patients With Oropharyngeal Cancer Interview with:

Dr. David Sher MD MPH Radiation Oncology, Harold C. Simmons Comprehensive Cancer Center UTSouthwestern Medical Center Associate Senior Editor International Journal of Radiation Oncology

Dr. Sher

Dr. David Sher MD MPH
Radiation Oncology,
Harold C. Simmons Comprehensive Cancer Center
UTSouthwestern Medical Center
Associate Senior Editor International Journal of Radiation Oncology What is the background for this study?

Response: The prevalence of oropharyngeal cancer is rising rapidly, and the two primary therapeutic approaches – upfront radiation therapy or surgery resection – have both been improving in terms of acute and late toxicity profiles. There is significant debate as to which therapy is better, and comparative data are necessary to help physicians and patients decide which paradigm is preferred for a given clinical scenario. Although there is a lot of anecdotal experience in comparing the two treatments, there really is a lack of published data on the question, and this is where our study fits in. What is the background for this study? Were there significant quality-of-life differences between the two treatment modalities?

Response: The main findings were comparable outcomes in long-term survival, toxicity and even cost between primary radiation therapy and primary surgery. This equivalence highlights the importance of patient-centered decision-making and engaging patient preferences in their optimal treatment approach. There was clearly an increase in stomach tube use in patients receiving primary chemoradiotherapy, which may be an important consideration in some patients, depending on the expected functional outcome of initial surgery. This difference became non-significant after a short period of time, but it was real and may influence decision-making. What should readers take away from your report?

Response: Readers should take away that there are no particularly large differences between these treatments. Survival, toxicity and cost are all comparable in the long-run. It was quite clear, though, that primary surgery was associated with a lower risk of gastrostomy tube use. Although the difference in tube use was negligible within a few months, the use of any feeding tube may be a deciding factor for some patients. We showed here this difference was due to concurrent chemotherapy during radiotherapy. This result echoes our clinical experience, but we were able to show this finding quite clearly. On the other hand, we also found that the increased dependence with radiation therapy was clearly short-lived, so patients should absolutely not consider this difference as a long-term problem preferentially associated with radiotherapy. What recommendations do you have for future research as a result of this work?

Response: It is critical for future research to consider the functional and quality-of-life outcomes in future comparisons of these different treatment approaches. Claims-based analyses such as this can uniquely show the “big picture” with respect to complications that require a medical treatment. However, more granular and subtle patient-reported outcomes are not included in this study, and they will be essential to help patients and physicians in the decision-making process.   

The study was funded by the Radiation Oncology Institute.


Sher DJ, Agiro A, Zhou S, Day AT, DeVries A. Commercial Claims–Based Comparison of Survival and Toxic Effects of Definitive Radiotherapy vs Primary Surgery in Patients With Oropharyngeal Squamous Cell Carcinoma. JAMA Otolaryngol Head Neck Surg. Published online September 20, 2018. doi:10.1001/jamaoto.2018.1929

Sep 21, 2018 @ 3:05 pm 

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