People with cancers of the head or neck seem to have better survival odds if they have private health insurance, research hints.

Head and neck cancers include cancers of the mouth, throat, nasal cavity, salivary glands and lymph nodes of the neck. Most cases are linked to smoking, with excessive drinking being the other major risk factor.

But while those habits may raise the odds of developing head and neck cancers, the new findings, reported in the journal Cancer, suggest that insurance coverage influences the odds of surviving.

Researchers found that among more than 1,200 patients treated at the Pittsburgh Medical Center between 1998 and 2007, those with private insurance had better survival rates than those with no insurance, as well as patients on Medicaid or Medicare disability.

Medicaid is the federal health insurance program for the poor; Medicare disability covers people younger than 65 who cannot work because of a serious disability or illness.

In this study, patients who were uninsured or on Medicaid were 50 percent more likely to die than privately insured patients. Those on Medicare disability had a 69 percent higher risk of dying — with factors such as age, race, income and smoking and drinking history taken into account.

Instead, the poorer survival seemed to be partly explained by later diagnosis. People without private insurance generally had more-advanced cancer by the time they saw a doctor, according to the researchers, led by Joseph Kwok of the University of Pittsburgh Cancer Institute.

It’s possible, they write, that these patients are less likely to get screened for head and neck cancers, or may have to delay treatment after a diagnosis.

The findings are based on 1,231 patients who underwent treatment for some form of head and neck cancer. Of the 547 patients with private insurance, 145 died during the study period; of 128 patients who were on Medicaid or were uninsured, 50 died; of 81 on Medicare disability, 39 died.

Older adults covered by traditional Medicare had similar survival odds as patients on private insurance.

Later diagnosis appeared to be a major factor in the link between insurance and cancer survival, Kwok and his colleagues found.

Across cancer types, uninsured and Medicaid patients were at greater risk of having advanced cancer than their privately insured counterparts. For example, when it came to laryngeal cancer — cancer of the voice box — they were seven times more likely to be at an advanced stage at the time of diagnosis.

Even though Medicaid patients have insurance coverage, the researchers note, they — like the uninsured — may be less likely to have routine dental check-ups, which often catch signs of oral cancer early.

They also point to other barriers — like transportation problems or getting time off from work to visit the doctor — that may prevent some uninsured and Medicaid/Medicare disability patients from having any early cancer symptoms assessed, or from starting treatment after a diagnosis.

On a more positive note, Kwok’s team did find that insurance had no influence over the risk of a cancer recurrence. That, they say, suggests that once patients begin treatment, they receive comparable care regardless of insurance status.

Menthol cigarettes appear to be more addictive for black and Hispanic smokers than regular cigarettes, a U.S. study has found.

Researchers from the School of Public Health at the University of Medicine and Dentistry of New Jersey (UMDNJ) analyzed data on 7,815 current and former smokers who’d reported at least one attempt to quit. The information came from the 2005 National Health Interview Survey.

Among adults who smoked menthol cigarettes, just 44 percent of blacks and 48 percent of Hispanics were able to kick the habit. But blacks and Hispanics who smoked regular cigarettes had higher quit rates — 62 percent and 61 percent, respectively. Those rates were similar to quit rates for white adults.

The data also showed that non-whites tended to smoke fewer cigarettes a day and were about three times more likely than whites to smoke menthol cigarettes, the study authors noted.

“Historically, tobacco companies have targeted minority populations when marketing menthol cigarettes,” study co-author Cristine Delnevo, director of the Center for Tobacco Surveillance and Evaluation Research at UMDNJ, said in a university news release.

“Although whites and non-whites have similar smoking prevalence rates, the fact that non-whites are more likely to smoke menthols, and those who smoke menthols are less likely to quit, could explain why minority populations continue to suffer disproportionately from tobacco-caused disease and death,” she said.

Study author Daniel Gundersen said in the news release that “with the substantial number of smokers smoking menthol cigarettes, particularly among minorities, this is serious cause for concern.”

FDA Recommendations

The reports of the adverse events led FDA to issue recommendations for patients using negative pressure wound therapy. If it is determined that you are a candidate for using NPWT at home, you should do the following:
Receive adequate training from a health professional (for example, your doctor, a nurse, or a home health care provider) so that you understand how to use your NPWT device. Demonstrate to your trainer that you know how to use the device properly.
Find out how long you should expect to use the device.
Understand the possible complications that may be associated with using the device. Know the warning signs so you can recognize complications early. Watch especially for bleeding, which can be life-threatening. If you see signs of bleeding, seek medical assistance immediately.
Before using NPWT at home, ask your health professional what to do if complications do occur. Find out
who to contact
how to recognize bleeding and serious infection
how to recognize if your wound condition is worsening
Get NPWT patient instructions (labeling) from your doctor, home health care provider, NPWT distributor, or the manufacturer’s Web site. Keep these instructions where you can easily find them.
Let your health professional know if you do not feel capable of managing the NPWT device at home. He or she might recommend that you be assisted by an appropriate caregiver.
Ask your health professional whether you need to stop taking aspirin or any other medications that affect bleeding or blood clotting, and what the associated risk is of stopping or avoiding such medicines.

Health professionals and consumers may report adverse reactions related to negative pressure wound therapy to FDA’s MedWatch Adverse Event Reporting program online, by regular mail, fax or phone.
Online
Regular Mail: Use FDA postage paid form 3500 and mail to MedWatch, 5600 Fishers Lane, Rockville, MD 20852-9787
Fax: 800-FDA-0178
Phone: 800-FDA-1088

Reports of Injuries, Deaths

Over the past two years, FDA has received six death and 77 injury reports associated with NPWT devices. Most deaths occurred at home or in long-term care facilities. Bleeding was the most serious complication, occurring in all six deaths and in 17 of the injuries.

According to these reports, extensive bleeding has occurred in patients
with blood vessel grafts in the leg
with breastbone or groin wounds
receiving medication for blood clots
during removal of dressings attached to the tissues

The reports also included cases of infections from original open infected wounds worsening due to pieces of dressing that remained in the wound, and of injury from foam dressing pieces and foam sticking to tissues or clinging to wounds. Most of these patients required surgery, additional hospitalization, and antibiotics.

FDA is addressing these problems and will continue monitoring adverse events associated with NPWT devices.

The Food and Drug Administration (FDA) has notified health professionals, and advised patients, about rare but serious complications—including deaths—from the use of negative pressure wound therapy (NPWT).

Negative pressure wound therapy devices can help in the healing and closure of wounds. They create negative pressure (a vacuum) at well-sealed wound sites that can help remove fluids and infectious materials and draws wound edges together.

FDA issued a notification to health professionals and advice for patients regarding the complications with NPWT on Nov. 13, 2009.

In the notifications, the agency alerted the public and health professionals that serious complications, especially bleeding and infection, have been reported in some patients using NPWT devices. These complications can occur wherever NPWT is used, including hospitals, long-term care facilities, and at home.