Racial disparities in the timely receipt of adjuvant radiotherapy for head and neck cancer

Allen M Chen; Jeremy P Harris; Tjoson Tjoa; Yarah Haidar; William B Armstrong

doi:10.1016/j.oraloncology.2023.106611

Racial disparities in the timely receipt of adjuvant radiotherapy for head and neck cancer

Oral Oncol. 2023 Dec:147:106611. doi: 10.1016/j.oraloncology.2023.106611. Epub 2023 Nov 11.

Authors

Allen M Chen¹, Jeremy P Harris², Tjoson Tjoa³, Yarah Haidar³, William B Armstrong³

Affiliations

¹ Departments of Radiation Oncology, University of California, Irvine, Chao Family Comprehensive Cancer Center, Orange, CA 92868, USA. Electronic address: allenmc2@uci.edu.
² Departments of Radiation Oncology, University of California, Irvine, Chao Family Comprehensive Cancer Center, Orange, CA 92868, USA.
³ Departments of Otolaryngology, University of California, Irvine, Chao Family Comprehensive Cancer Center, Orange, CA 92868, USA.

PMID: 37956484
DOI: 10.1016/j.oraloncology.2023.106611

Abstract

Purpose: To evaluate the influence of socioeconomic and demographic factors which might predict for excessive delays in the receipt of adjuvant radiotherapy for head and neck cancer.

Methods and materials: The medical records of 430 consecutive patients referred for adjuvant radiation after surgical resection for squamous cell carcinoma of the head and neck were reviewed. The number of days from surgery to initiation of radiation was recorded. To study the variability in which adjuvant radiation was delivered, descriptive statistics were used to determine the percentage of patients who deviated from starting treatment beyond the recommended benchmark of 42 days. The chi-square statistic was used to compare differences in proportion among subsets. A Cox proportional hazards model was constructed to perform a multi-variate analysis to identify factors which independently influenced the likelihood for non-adherence.

Results: The interval between surgery and the start of radiation therapy ranged from 5 to 128 days (mean, 36 days). The mean number of days from surgery to radiation therapy was 31 days, 35 days, 40 days, and 42 days for Caucasians, Asians, Latino, and Black patients (p = 0.01). In all, 359 of 430 patients (83 %) started adjuvant radiation within 42 days. The proportion of patients who initiated radiation therapy within 42 days of surgery was 91 %, 86 %, 71 %, 65 %, and 80 % for Caucasians, Asians, Latinos, Blacks, and Native Hawaiian/Pacific Islanders, respectively (p < 0.001). Patient characteristics associated with higher odds of non-adherence to the timely receipt of adjuvant radiation therapy within then 42-day benchmark from surgery to radiation included race ([OR] = 4.23 95 % CI (1.30-7.97), non-English speaking status ([OR] = 2.38, 95 % CI: 0.61-4.50), and low socioeconomic status ([OR] = 1.21, 95 % CI: 1.01-1.86).

Conclusion: Underrepresented minorities are more likely to experience delays in the receipt of adjuvant radiation for head and neck cancer. The potential underlying reasons are discussed.

Keywords: Adjuvant; Disparities; Head and Neck Cancer; Radiation Therapy; Timely.

MeSH terms

Carcinoma, Squamous Cell* / pathology
Head and Neck Neoplasms* / radiotherapy
Healthcare Disparities*
Humans
Proportional Hazards Models
Racial Groups
Radiotherapy, Adjuvant
Retrospective Studies
Time-to-Treatment*