Characterizing Treatment Delays in Patients With HPV-Negative Oropharyngeal Cancer

Although the impact of increased time to treatment initiation (TTI) on outcomes for patients with oropharyngeal squamous cell carcinoma (OPSCC) has been well-studied, a deeper understanding of the mechanisms underlying delay in patients with human papillomavirus (HPV)-negative OPSCC is lacking in the current literature.

To assess differences in sociodemographic factors and treatment timelines between patients with HPV-negative OPSCC with shorter versus. longer TTI.

Patients treated for HPV-negative OPSCC at a single academic institution between 2013 and 2023 were retrospectively identified via chart review and dichotomized by the cohort median TTI (53.5 days; defined as the time from biopsy to first treatment initiation). Clinical timelines between delayed and nondelayed patients were compared using descriptive statistics and Mann-Whitney U testing. Independent predictors of delayed TTI (> 53.5 days) were evaluated using multivariate logistic regression modeling, with adjusted odds ratios (aORs) and 95% confidence intervals reported.

Seventy-six patients were identified. On multivariable analysis, male sex (aOR 3.28; 95% CI 1.02-10.49), unmarried status (aOR 5.96; 95% CI 1.36-26.07), primary chemoradiation versus surgery (aOR 0.25; 95% CI 0.07-0.85), and biopsy available before arrival (aOR 4.08; 95% CI 1.32-17.36) were independently and significantly (p< 0.05) associated with delayed treatment initiation. Treatment timeline analysis revealed that both the interval from biopsy to referral and the interval from PET scan to treatment initiation differed significantly between delayed and nondelayed patients (p< 0.05).

Primary nonsurgical treatment and lack of social support were found to be independently associated with treatment delay in patients with HPV-negative OPSCC. These findings highlight opportunities for improving the care of HPV-negative OPSCC at the specialty level.