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

BackgroundIn the US, 72,000+ adults are diagnosed with Head and Neck Cancer (HNC) annually. Despite improving outcomes overall, place-based disparities persist at the extremes of the care continuum. While existing evidence has emphasized the disparities at diagnosis, less is known about how patterns of care differ after diagnosis. To inform system-level strategies to improve care delivery in low-income communities, we aimed to evaluate place-based disparities in type of treatment received and time-to-treatment initiation for HNC patients. MethodsWe analyzed Surveillance, Epidemiological, and End Results (SEER) case data (2018-2022). Our first mutually exclusive set of binary outcomes related to the type of treatment received were categorized as surgery only, surgery with adjuvant radiotherapy, definitive chemoradiation, radiation or chemotherapy alone, or no treatment. Our second set of binary outcomes related to time from diagnosis to treatment initiation: 0-29, 30-59, 60-89, and 90+ days. Linear probability and multinomial regression models adjusted for tumor site, stage, sociodemographics, and geography to estimate the association between residing in a low-income county (<80k median household income) and differences in the probability of each outcome. ResultsOur sample included 70,468 HNC cases. We found no place-based differences for adjuvant or definitive treatment. Compared to patients in high-income counties, patients in low-income counties were 1.1%-points less likely to receive surgery only (-2.2, -0.1) and 1.0%-points more likely to receive radiation or chemotherapy alone (0.1,1.8); and 2.1%-points less likely to begin treatment within 0-29 days (-3.7, -0.4) and 1.4%-points more likely to delay treatment until 60-89 days (0.5, 2.3). These differences remained consistent across nearly all sociodemographic subgroups. ConclusionOur findings warrant implementing and evaluating system-level interventions to promote access to high-quality, timely HNC treatment in low-income communities. The extent to which place-based disparities in treatment influence disparities in survival remains unknown.