Financial instability, insurance, and transportation influence timely head and neck cancer care in the United States: Patient and healthcare worker perspectives

Affiliations

¹ Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Yale University School of Medicine, New Haven, CT, USA.
² Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School and Massachusetts Eye and Ear, Boston, MA, USA.
³ Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA; Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital; Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
⁴ Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital; Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
⁵ Department of Otolaryngology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
⁶ Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School and Massachusetts Eye and Ear, Boston, MA, USA; Department of Otolaryngology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
⁷ Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
⁸ Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA.
⁹ Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA; Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital; Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, MA, USA. Electronic address: rbergmark@bwh.harvard.edu.

PMID: 40907281
DOI: 10.1016/j.oraloncology.2025.107607

Financial instability, insurance, and transportation influence timely head and neck cancer care in the United States: Patient and healthcare worker perspectives

Sana Batool et al. Oral Oncol. 2025 Oct.

. 2025 Oct:169:107607.

doi: 10.1016/j.oraloncology.2025.107607. Epub 2025 Sep 3.

Authors

Affiliations

¹ Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Yale University School of Medicine, New Haven, CT, USA.
² Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School and Massachusetts Eye and Ear, Boston, MA, USA.
³ Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA; Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital; Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
⁴ Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital; Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
⁵ Department of Otolaryngology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
⁶ Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School and Massachusetts Eye and Ear, Boston, MA, USA; Department of Otolaryngology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
⁷ Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
⁸ Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA.
⁹ Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA; Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital; Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, MA, USA. Electronic address: rbergmark@bwh.harvard.edu.

PMID: 40907281
DOI: 10.1016/j.oraloncology.2025.107607

Abstract

Introduction: Delays in head and neck cancer (HNC) diagnosis and treatment and financial burdens of care are often rooted in social determinants of health (SDOH), such as financial instability, socioeconomic status (SES), health insurance status, and transportation barriers. While these factors are well recognized, their underlying impact on access to care remains underexplored; this qualitative study aims to investigate how these SDOH facilitate or hinder HNC care through insights from patients and healthcare workers (HCWs) in the United States, to identify targets for intervention.

Methods: Semi-structured interviews were conducted with patients with newly diagnosed HNC, and HCWs caring for these patients, between June 2022 and July 2023. Audio-recorded interviews were transcribed. Iterative deductive and inductive analysis was performed using NVivo 1.7.1 with two coders to identify mechanisms by which SDOH shaped HNC care processes.

Results: A total of 72 participants were interviewed, including 42 patients with HNC (mean age 57 years, range 19-81; 64 % female; 81 % white) and 30 HCWs (mean age 42 years, range 20-68; 77 % female; 83 % white). In analysis, three mechanisms were identified: (1) socioeconomic instability forces patients to make critical choices, (2) the added burden of addressing health insurance gaps falls on patients, and (3) transportation-related financial and logistical barriers disrupt care processes.

Conclusion: Financial instability, insurance gaps, and transportation challenges create barriers to HNC care for disadvantaged patients. Understanding these SDOH can improve care timeliness and patient experiences.

Keywords: Access to care; Delay; Financial instability; Head and neck cancer; Insurance; Social determinants of health; Transportation.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Sana Batool has received research funding from the Harvard Medical School Office of Scholarly Engagement. Eleni Rettig receives unrelated in-kind research assay support from Naveris. Daniel Faden has received research funding or in-kind funding from Bristol-Myers Squibb, Calico, Predicine, BostonGene, Neogenomics. He has received consulting fees from Merck, Noetic, Chrysalis Biomedical Advisors, Arcadia and Focus. He has received salary support from Bristol-Myers Squibb, Calico, NIH K23, NIH R21 and NIH R03 grants. All of these disclosures are unrelated to the current work in this manuscript. Gezzer Ortega has unrelated support from the NIH NIMHD K23MD016129. Daniel Dohan received related support from the NIH NIA K07AG066814 to provide qualitative research method mentorship. Regan Bergmark has related faculty grant support as the H. Richard Nesson Fellow at Brigham and Women's Hospital to investigate access to surgical care, and unrelated clinical trial funding from I-Mab Biopharma (CTA: HLW-ALZ-NAS-001). All other authors declare there is no conflict of interest.

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Financial instability, insurance, and transportation influence timely head and neck cancer care in the United States: Patient and healthcare worker perspectives

Affiliations

Financial instability, insurance, and transportation influence timely head and neck cancer care in the United States: Patient and healthcare worker perspectives

Authors

Affiliations

Abstract

Conflict of interest statement

MeSH terms

LinkOut - more resources

Full Text Sources

Medical