Association of Policy With Palliative Care Uptake in Patients With Head and Neck Cancer.

Abstract

Head and neck squamous cell carcinoma presents substantial symptom burdens in advanced stages, yet only a small fraction of patients receive palliative care (PC). Medicaid expansion and state-specific PC policies may influence PC uptake in this population. This study evaluates the impact of Medicaid expansion and state-level PC laws on PC utilization among patients with stage III and IV HNC across the United States. Using 2015-2020 National Cancer Database (NCDB) data, we identified deceased HNC patients with stage III or IV cancer and prognoses under 6 months. Using adjusted logistic regression, we analyzed the role of Medicaid expansion in PC utilization. Additionally, the Yale Palliative Care GPS was used to assess the distribution of state PC laws. Of 10 305 eligible patients, 69.7% were from Medicaid expansion states. Medicaid expansion (aOR: 1.22, 95% CI: 1.01-1.49), higher Charles Comorbidity Index (CCI ≥ 3 vs. CCI = 1, aOR: 1.84, 95% CI: 1.16-2.81), and later years were associated with increased PC use. Geographic differences in PC law implementation were observed, with the West having the most enacted/passed laws while the Northeast had the highest PC utilization rate. Medicaid expansion and specific state PC laws positively impact PC access for advanced HNC patients. These findings underscore the potential of policy interventions in enhancing PC accessibility and utilization among vulnerable cancer populations.