Place-Based Disparities in Treatment and Time-to-Initiation for Head and Neck Cancer

Area of Science:

• Oncology
• Health Services Research
• Health Disparities

Background:

• Head and neck cancer (HNC) affects over 72,000 US adults annually.
• Persistent place-based disparities exist in HNC outcomes, particularly after diagnosis.
• Limited research addresses post-diagnosis care patterns and their geographic variations.

Purpose of the Study:

• To investigate disparities in head and neck cancer (HNC) treatment patterns based on county income level.
• To analyze differences in treatment type and timeliness between patients in low-income versus high-income counties.
• To identify potential inequities in the delivery of HNC care.

Main Methods:

• Utilized an observational, repeated cross-sectional design with Surveillance, Epidemiology, and End Results (SEER) case data (2018-2022).
• Analyzed treatment outcomes: surgery only, surgery with adjuvant radiotherapy, definitive chemoradiation, radiation/chemotherapy alone, or no treatment.
• Examined time from diagnosis to treatment initiation (0-29, 30-59, 60-89, 90+ days) using regression models adjusted for confounders.

Main Results:

• No significant place-based differences were found for adjuvant or definitive treatments.
• Patients in low-income counties were less likely to receive surgery only and more likely to receive radiation or chemotherapy alone.
• Patients in low-income counties were less likely to start treatment within 0-29 days and more likely to experience treatment delays (60-89 days).

Conclusions:

• Place-based disparities in head and neck cancer (HNC) treatment patterns persist, particularly concerning timeliness and treatment modality.
• System-level interventions are crucial to ensure equitable access to high-quality, timely HNC care in low-income communities.
• Further research should evaluate the impact of interventions aimed at reducing HNC care disparities.