Head and Neck Cancer: Understanding Gaps in Insurance Coverage

As April draws to a close, it remains crucial to acknowledge the significance of ensuring patients with head and neck cancer receive equitable care. Improving access to insurance coverage is an important step. According to the American Dental Association, nearly a quarter of adults aged 19-64 lack dental insurance. That figure skyrockets to 47% among Medicare beneficiaries. This stark contract in coverage disproportionately impacts marginalized communities, including Black, Hispanic, and lower-income individuals, further exacerbating health inequities.

Despite the widely recognized importance of dental care, its critical role in the treatment journey of patients with head and neck cancers is often underemphasized. As advancements in cancer therapy—particularly radiotherapy—continue to evolve, so too does the reliance on multidisciplinary teams, where dental professionals play an indispensable role. From pre-radiotherapy evaluations to post-treatment rehabilitation, dental care encompasses a spectrum of interventions crucial for optimizing treatment outcomes and preserving quality of life for patients with head and neck cancer.

However, the lack of insurance coverage poses a significant barrier as it impedes patient access to essential dental services which ultimately hinders treatment outcomes. As a result, understanding the essential dental services patients with head and neck cancer require is key. They include, but are not limited to:

• Pre-radiotherapy Dental Evaluation and Clearance: Prior to starting radiotherapy, patients with head and neck cancers undergo a thorough dental evaluation to assess their oral health status. This evaluation includes dental extractions for teeth with poor prognosis and measures to maintain good oral hygiene, aiming to minimize the risk of treatment-related complications and ensure optimal oral health before initiating cancer therapy.
• Management of Treatment-Related Complications: Radiotherapy for head and neck cancers can lead to various acute and chronic side effects, including oral mucositis, xerostomia (dry mouth), taste disturbances, and trismus (muscle spasms in temporomandibular joint). Dental care providers play a crucial role in managing these complications through pharmacological and non-pharmacological treatments.
• Radiation Caries and Osteoradionecrosis Management: Patients undergoing radiotherapy are at risk of developing radiation caries and osteoradionecrosis. Dental restorative treatments for caries in irradiated teeth require careful management to prevent tooth loss. Advanced adhesive techniques and minimal invasive dentistry are employed to provide dental treatment for patients with radiation caries.
• Prosthetic and Restorative Dentistry: Post-radiotherapy, patients with head and neck cancer may require oral rehabilitation to address missing teeth and restore oral function. Treatment options include removable partial dentures, fixed prosthesis, and dental implants with or without retained fixed or removable prostheses.
• Regular Post-radiotherapy Review and Follow-up: After completing radiotherapy, patients with head and neck cancers require regular dental review appointments to monitor their oral health status and address any treatment-related complications. Patients are assessed for oral rehabilitation options, and decisions are made in their best interest.

Not only are these dental care needs vital for patients with head and neck cancer, but studies reveal higher survival rates from head and neck cancer when care is provided by a dedicated team that meets regularly. However, the logistical challenges of assembling such teams can be daunting, and the lack of insurance coverage can exacerbate these difficulties. These factors have created a positive correlation between the level of insurance coverage and patient survival rates. The image below illustrates this relationship: 

Source

The same factors influencing overall survival post-head and neck cancer diagnosis—insurance coverage and socioeconomic status—are also linked to a lack of dental coverage. While policymakers have previously endeavored to extend dental coverage to new patient populations, including Medicare, there is an urgent need for patients with head and neck cancer. Consequently, policymakers and advocates must collaborate to devise solutions to this access crisis. For developing initiatives to fix this problem is a major part of why the Association of Cancer Care Centers (ACCC) and other organizations continue to recognize April as Head and Neck Cancer Awareness Month.  

In an upcoming post, ACCCBuzz will speak with 2 patient advocacy organizations leading the charge for comprehensive dental coverage for all individuals facing head and neck cancer. Stay Tuned!