Timely Matters: Predictors of Delay in Oral Cavity Cancer Patients Across the Care Continuum

Nicholas Correia; Kennedy Johnson; Megan Durr; Barbara A Grimes; Ann A Lazar; Urmimala Sarkar; Patrick K Ha; Laura Chen; Katherine C Wai; Ilya Likhterov; Sue S Yom; Jason W Chan; Alain P Algazi; Hyunseok Kang; William R Ryan; Chase M Heaton; Ivan El-Sayed; Jonathan George; Mary Jue Xu

doi:10.1002/lio2.70363

Timely Matters: Predictors of Delay in Oral Cavity Cancer Patients Across the Care Continuum

Laryngoscope Investig Otolaryngol. 2026 Feb 27;11(2):e70363. doi: 10.1002/lio2.70363. eCollection 2026 Apr.

Authors

Nicholas Correia¹, Kennedy Johnson², Megan Durr², Barbara A Grimes³, Ann A Lazar³, Urmimala Sarkar⁴, Patrick K Ha², Laura Chen¹, Katherine C Wai², Ilya Likhterov², Sue S Yom⁵, Jason W Chan⁵, Alain P Algazi⁶, Hyunseok Kang⁶, William R Ryan⁷, Chase M Heaton², Ivan El-Sayed², Jonathan George², Mary Jue Xu^{2

8}

Affiliations

¹ School of Medicine, University of California San Francisco California USA.
² Department of Otolaryngology-Head and Neck Surgery University of California San Francisco California USA.
³ Department of Epidemiology and Biostatistics University of California San Francisco California USA.
⁴ Division of General Internal Medicine University of California San Francisco California USA.
⁵ Department of Radiation Oncology University of California San Francisco California USA.
⁶ Department of Medicine University of California San Francisco California USA.
⁷ Sutter California Pacific Otolaryngology San Francisco California USA.
⁸ Center for Health Equity in Surgery and Anesthesia, University of California San Francisco California USA.

Abstract

Objective: Limited literature focuses on delays in accessing head and neck cancer (HNC) care across the entire care continuum. This study aims to describe the time to care from symptom onset to treatment completion and identify predictors of delays for oral cavity cancer patients.

Methods: We reviewed patients with oral cavity squamous cell carcinoma (OCSCC) treated with curative surgery followed by adjuvant treatment at a tertiary center. Delays were defined per published thresholds for: time to treatment initiation (TTI, diagnosis to surgery), time to adjuvant treatment (stratified by whether adjuvant treatment was at the same or different facility as surgery), and total treatment package time. We also measured symptom duration, reported median times, and used logistic regression to assess predictors of delay.

Results: Among 93 patients, median (IQR) symptom duration was 17.4 weeks (IQR: 6.8-42.8); TTI 6.9 weeks (IQR: 4.4-10.4); time to adjuvant radiation 8.4 weeks (IQR: 7.4-9.3) at the same institution as surgery was performed and 9.3 weeks (IQR: 7.4-14) at a different facility; and total treatment package time 15.4 weeks (IQR: 12.6-20) for surgery and adjuvant radiation, and 16.3 weeks (IQR: 15-18.6) for surgery and adjuvant chemoradiation. 73% of patients experienced delays in reaching a healthcare facility, 39% in TTI, 89% in starting adjuvant treatment, and 64%-81% in total treatment time. In univariate analyses, late-stage disease, residing in a community with higher social vulnerability index (SVI), longer time from surgery to pathology report, need for free flap, and social worker interaction were associated with higher odds of delay in any care interval following diagnosis. Higher SVI was associated with delays in multivariate analyses.

Conclusion: HNC patients experience delays during all phases of cancer care. Interventions and future research need to address social determinants of health and health system factors that contribute to multifactorial delays across the care continuum.

Keywords: delays; head and neck cancer; health disparities.