Socioeconomic influence on treatment and outcome of patients with oral cancer in Germany

Abstract

Purpose: To illustrate the influence of different socioeconomic factors on the treatment and outcome of patients in Germany with oral cancer.

Methods: In this retrospective single-center study, 400 patients of our department of oral and maxillofacial surgery with primary cases of oral cancer were included. Preoperative diagnostics, occupational groups, and marital and health insurance status were evaluated. Overall and disease-specific survival were analyzed. Occupations were distinguished in 5 groups (unemployed, physically light workers, physically hard worker, university graduate, and freelancer). Data were adjusted to covariables like tumor size, positive lymph nodes, age, alcohol, or tobacco abuse.

Results: There was no differences between private and statutory insured patients concerning overall (p = 0.858) or disease-specific survival (p = 0.431). Private insured patients received more preoperative PET-CT (p = 0.046) and had a better dental status (p = 0.006). The occupational groups showed also no differences in survival (p = 0.963). The hospitalization of freelancers was in average 2 days shorter. Physically hard workers were diagnosed with bigger tumors (p = 0.018) and consumed more tobacco and alcohol. The 5-year survival rate of married patients was approximately 20% points better than not married patients, without showing a significant difference over the entire observation time (p = 0.084).

Conclusion: In our cohort, socioeconomic factors have just a limited influence on the survival or treatment of patients with oral cancer. A sufficient statutory health insurance system is a reasonable explanation for this.

Keywords: Health insurance; Marriage; Occupation; Oral cancer; Socioeconomic factors; Survival.

Fig. 1

Kaplan Meier for overall survival showed no difference between statutory and private insured patients (p = 0.858)

Fig. 2

Kaplan Meier for overall survival showed no difference between married and not married patients. Married patients had a better 5-year survival rate (70.8%) than not married (single, divorced, widowed) patients (53.7%)