Association between neurological disorders and negative outcomes in head and neck cancer patients during the COVID era: An analysis of health outcomes and economic impact.

Abstract

e18042 Background: Head and neck cancers (HNC) are associated with significant morbidity and healthcare challenges, often complicated by neurological issues that can exacerbate patient outcomes and increase treatment complexities. Despite the prevalence of these complications, there is a paucity of data regarding their impact on healthcare utilization and patient demographics. This study aims to fill this gap by examining the disparities in health outcomes and resource use among patients with head and neck cancers who develop neurological complications. Methods: We utilized national inpatient database from 2021 to examine patient and clinical characteristics. We employed generalized linear models to examine the association between neurological complications and their impact on health outcome of hospitalized head and neck cancer patients – such as total charge, length of stay (LOS), in-hospital mortality, emergency visits, and infection risks after controlling for clinical and patient variables. Results: Among 51,295 patients hospitalized with HNC, 6320 patients had neurological complications (NC). In the adjusted analysis, patients with NC were associated with higher healthcare costs (Coeff: 1.38; 95% CI, 1.26-1.51), and longer LOS (Coeff, 1.25; 95% CI, 1.07-1.42). Similarly, patients with NC exhibited higher rates of hospital-associated complications (HAC) (aOR:1.92; 1.64-2.24), COVID-19 infections (aOR:1.66; 1.16-2.38), septicemia (1.90; 1.62-2.23) fluid and electrolyte imbalance (fed), (1.65; 1.35-2.02), ED visits (1.33; 1.09-1.61) and in-hospital mortality (2.42; 1.96-2.99). Compared to Whites, Hispanics and Others were associated with higher healthcare costs (1.35; 1.19-1.53), (1.26; 1.11-1.42) and lower fed (0.48; 0.35-0.67), (0.41; 0.28-0.60) while longer LOS for Blacks (1.25, CI = 1.07–1.45) and Hispanics (1.24, CI = 1.03–1.49). Among patients with NC, Medicaid and other/self-payers had higher mortality (1.64; 1.23-2.20), (1.73; 1.18-2.54) compared to Medicare. HNC NC patients living in rural (micropolitan) areas had lower HAC (0.77; 0.63-0.93) compared to those living in urban areas. Patients with NC with low-income status had lower COVID infections (0.52; 0.34-0.77) compared to those with high-income status. Overall, these findings underscore the increased economic burden and poorer clinical outcomes for head and neck cancer patients with NC, particularly among racial groups other than Whites. Conclusions: This study highlights the substantial burden of neurological complications in patients hospitalized with head and neck cancers during the COVID era, associated with increased healthcare costs and worse clinical outcomes. These disparities underscore the urgency of developing targeted interventions to improve care and outcomes for this vulnerable population.