Edward Christopher Dee, Resident Physician in Radiation Oncology at Memorial Sloan Kettering Cancer Center, shared Sudarshan Ramanan’s post on X, adding:
“Excited to share our new paper in Oral Oncology, led by Sudarshan Ramanan and George Ashji!
Can socioeconomic and geographic barriers compound one another to affect cancer care? We examined this in postoperative radiation for oropharyngeal cancer.
Title: The double jeopardy effect of socioeconomic barriers on guideline-concordant postoperative radiation in oropharyngeal cancer
Authors: Sudarshan Ramanan, George Ashji, Nishant Chadha, Yingzhi Wu, Achraf Shamseddine, Yao Yu, Edward Christopher Dee, Nancy Y Lee
Using the NCDB, we studied 2,625 patients with intermediate- or high-risk oropharyngeal cancer after surgery.
Only 74.3% received indicated postoperative RT.
Receipt differed substantially by risk group:
- High-risk: 79.6%
- Intermediate-risk: 53.5%
A meaningful gap in care.
Figure 1: Insurance matters.
After adjustment, patients with Medicaid (OR 0.72) or Medicare (OR 0.76) had lower odds of receiving postoperative RT than privately insured patients.
And uninsured patients experienced more delays in starting RT.
Predicted RT receipt:
- Private insurance, near: 79.8%
- Private, far: 69.4%
- Uninsured, near: 73.1%
- Uninsured, far: 52.1%
The combined disadvantage exceeded the additive expectation by 10.7 percentage points. A potential double jeopardy effect.
Receipt of postoperative RT was associated with better survival in a matched analysis, although causality cannot be established.
Our takeaway: financial and geographic barriers should be addressed together.
So proud of Sudarshan Ramanan and George Ashji and grateful to our team and mentors Drs Nancy Lee, Yao Yu and Achraf Shamseddine.”
Sudarshan Ramanan, Medical Student at the Thomas Jefferson University’s Sidney Kimmel Medical College, shared:
“Happy to share our new paper in Oral Oncology. We examined how socioeconomic factors influence the receipt of postoperative radiation therapy in oropharyngeal cancer.”
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