Dental Care May Cause Financial Burdens in Head and Neck Cancer

Patients with head and neck cancer undergoing treatment who also require dental treatment may experience financial burdens because most private medical insurance does not reimburse for these dental treatments.

In a survey study published in JAMA Otolaryngology-Head and Neck Surgery, 85 patients with head and neck cancer completed a survey that asked about cancer treatment, their current oral health status, frequency of dentist visits, total out-of-pocket dental treatment expenses and reported financial hardship because of post-cancer treatment dental care.

Of note, tumor sites included the mouth, the base of the tongue and oropharynx (middle section of the throat). The median education level among patients in the study was a bachelor’s degree and the household income ranged approximately between $80,000 and $100,000.

Among the 85 patients who answered the survey, 67 patients (79%) reported that their oncologist recommended receiving dental screening at the beginning of their cancer care, according to the study. Those who adhered to the recommendation included 71 patients (84%). However, patients who reported not receiving the recommended dental treatment most commonly reported that it was because of finances or the cost of treatment (four of 28 patients).

For patients who received dental services before cancer treatment, 23 stated that 56% of their services were paid out-of-pocket, which the study authors noted was similar to the general population, regardless of cancer status.

“In this survey study, both acute and late oral complications were reported in patients treated for [head and neck cancer],” the study authors wrote. “In particular, pathologies specifically affecting the teeth and periodontium were almost universal in this population, largely as a consequence of radiotherapy-associated xerostomia (dry mouth).”

READ MORE: Brush Up on Oral Hygiene After Cancer

Dental Care After Head and Neck Cancer Treatment

After receiving treatment for head and neck cancer, 59 of 85 patients (69%) reported that their oral health was worse or significantly worse than before cancer treatment. Notably, 11 patients reported visiting the dentist more than twice a year before undergoing cancer treatment, whereas 54 patients stated that they only did so after having received cancer treatment.

The majority of patients (73 of 85 patients; 86%) noted that they experienced an oral or dental complication associated with their cancer treatment. These complications included xerostomia, dental caries (tooth decay or cavities) and oral mucositis (painful inflammation in the mouth), the study stated. Among these patients, 64 reported having follow-up dental procedures, such as professional cleanings, teeth extractions and fillings.

Regarding cost, 60% of charges for cancer treatment-related dental care were paid out-of-pocket, according to the study. Among 84 patients, 33 patients (39%) reported self-pay costs of $5,000 or more for dental care pre-cancer and post-cancer treatment. In the total population of patients in the study, 39% said that their dental care after cancer treatment caused them financial hardship, according to the study survey.

Specifically, patients who reported that their dental care after cancer treatment was less than $3,000 “had a decrease in odds of experiencing financial toxicity (challenges associated with the cost of medical care) compared with those with expenses totaling $3,000 or more,” researchers wrote.

“While these complications may have been associated with cancer treatment, medical third-party payers typically do not cover costs associated with their treatment, which results in substantial financial burdens for some patients and their families,” the study authors wrote. “Given the association of [head and neck cancer] treatment with oral health and the subsequent necessity of dental care that is traditionally not paid for by medical insurers, more work appears to be needed to increase coverage for these patients to afford them access to this care.”

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