Neighborhood-Level Disadvantage and Delayed Adjuvant Therapy in Head and Neck Cancer

Area of Science:

• Oncology
• Public Health
• Health Services Research

Background:

• Timely postoperative radiation therapy (PORT) is crucial for head and neck squamous cell carcinoma (HNSCC) treatment outcomes.
• While individual socioeconomic status impacts PORT receipt, neighborhood-level disadvantage remains understudied.
• National guidelines recommend initiating PORT within 6 weeks of surgery for HNSCC.

Purpose of the Study:

• To investigate the association between neighborhood-level disadvantage and delays in receiving guideline-adherent PORT for HNSCC patients.
• To quantify the impact of area deprivation on the timeliness of postoperative radiation therapy.

Main Methods:

• Retrospective cohort study of 681 HNSCC patients undergoing surgery and PORT across 4 US academic medical centers (2018-2020).
• Area Deprivation Index (ADI) scores at the census block level were used to measure neighborhood disadvantage.
• Multivariable logistic regression and Cox models analyzed the association of ADI with PORT delay and time-to-PORT (TTP), adjusting for patient, clinical, and institutional factors.

Main Results:

• A significant PORT delay rate of 60.8% was observed.
• Higher Area Deprivation Index (ADI) scores were independently associated with increased odds of PORT delay (aOR, 1.32 per 25-point increase).
• Increasing ADI quartiles correlated with longer time-to-PORT, indicating a dose-dependent relationship.

Conclusions:

• Neighborhood-level disadvantage is a significant, independent factor contributing to delays in guideline-adherent PORT for HNSCC.
• These findings highlight the need for multilevel interventions to ensure equitable access to timely cancer treatment.
• Addressing area deprivation is essential for improving cancer care delivery and patient outcomes.