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. 2024 Sep 1;150(9):811-818.
doi: 10.1001/jamaoto.2024.2260.

Financial Burden of Dental Care Among Patients With Head and Neck Cancer

Betty Ben Dor  1 , Alessandro Villa  2 , Catherine Hayes  3 , Elizabeth Alpert  3 , Donald S Shepard  4 , Stephen T Sonis  1   5
Affiliations

Financial Burden of Dental Care Among Patients With Head and Neck Cancer

Betty Ben Dor et al. JAMA Otolaryngol Head Neck Surg. .

Abstract

Importance: Patients undergoing treatment for head and neck cancer (HNC) experience oral complications requiring substantial dental treatment. This treatment is commonly not reimbursed by medical insurers, presenting a potential financial burden for patients.

Objective: To characterize the dental care needs and associated cost burden for patients with HNC.

Design, setting, and participants: This survey study included Head and Neck Cancer Alliance (HNCA) members who were surveyed from March 23 to October 27, 2023, using Qualtrics. The survey was promoted using the HNCA's social media and email list. Data analysis was performed between October 2023 and May 2024.

Main outcomes and measures: Main outcomes were oral and dental complications of cancer treatment among patients with HNC, the association of cancer treatment with dental care use, and costs of associated dental treatment.

Results: Of 100 individuals administered the survey, 85 (85%) completed all required questions and were included in the analysis. Of 84 participants with age and sex data, 51 (61%) were aged 65 years or older and 45 (54%) were female. Of 85 respondents, 59 (70%) indicated that their current oral health was worse than before cancer treatment. Most respondents (73 of 85 [86%]) endorsed oral complications from cancer treatment, including xerostomia (66 of 73 [90%]), caries (35 of 73 [48%]), and oral mucositis (29 of 73 [40%]); 64 of 73 respondents (88%) required follow-up dental treatment. Overall, 4 of 28 (14%) before HNC treatment and 17 of 53 (32%) after treatment reported finances as the reason that not all recommended dental care was received. A total of 33 of the 85 respondents (39%) said that their postcancer dental care had caused them financial hardship. Individuals who were less likely to endorse financial hardship were more likely to have greater educational attainment (odds ratio [OR], 0.20; 95% CI, 0.06-0.58), higher income (OR, 0.33; 95% CI, 0.11-0.94), increased pre-HNC dental visit frequency (OR, 0.30; 95% CI, 0.10-0.86), same or better oral health after HNC (OR, 0.13; 95% CI, 0.02-0.50), and lower out-of-pocket dental expenses after HNC (OR, 0.09; 95% CI, 0.03-0.29).

Conclusions and relevance: In this survey study, most patients undergoing treatment for HNC required extensive dental treatment throughout cancer treatment; this treatment presented a financial burden for 39% of patients that was a limiting barrier to care. Since most private medical insurers do not reimburse for dental treatment, more comprehensive coverage deserves policy attention.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Villa reported receiving grants from Mureva, Merck, PCCA, and Meiragtxt and personal fees from K Pharmaceuticals, Primary Endpoint Solutions, Afyx Therapeutics, and Lipella outside the submitted work. Dr Sonis reported receiving personal fees from Biomodels, LLC, and Primary Endpoint Solutions, LLC, outside the submitted work. No other disclosures were reported.

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