To the Editor We read with interest the article by Massa et al,1 which reported the increasing fiscal burden facing survivors of head and neck cancer (HNC). Although we do not disagree with the authors’ overall conclusions, we believe that the level of financial burdens in the study population was underestimated.

Not shown in the analysis, probably as a function of the limitations of the queried database, are costs incurred by treatment-associated dental and oral care. When a large-scale claims database was queried that contained both medical and dental claims, considerable costs for dental and oral care were consistently noted among survivors of HNC.2