(165) Effects of Socioeconomic Status on Timing of Adjuvant Cancer Therapy

Introduction: Initiation of adjuvant therapies within 6 weeks in patients with head and neck cancer is associated with improved survival, and a delay of > 14 weeks is associated with increased risk of death. Recent studies have found that lower socioeconomic status was associated with higher rate of adjuvant therapy delay, therefore we performed an institutional analysis to evaluated rate of adjuvant therapy delay based on socioeconomic status in Western New York.

Methods: Medical records of patients ≥18 years old, diagnosed with head and neck cancer, and were recommended adjuvant radiation and/or chemotherapy from 2011-2022 were queried from a large multi-center academic hospital in Western New York. Primary outcomes were demographics, average time between surgery and initiation of adjuvant therapy, and rate of adjuvant therapy delay based on socioeconomic status.

Results: 216 patient records were reviewed. Patients who were not recommended adjuvant therapy, who declined adjuvant therapy and/or without available records for review were excluded. 69 patients were included. 30.5% were female, 69.5% were male. Average time to adjuvant therapy was 52.8 days (21-173 days). Only 15.9% of patients received adjuvant treatment in ≤ 6 weeks. Socioeconomic information was inferred by median household income based on zip code according to the United States Census from years 2017-2021. Patients who were below average median household income for our patient population were more likely to experience delay in their adjuvant treatment (92% vs. 73.3%, p < 0.01) and they were also more likely to be referred to an outside hospital for adjuvant therapy due to travel distance (20% vs. 6%). There was no difference in the rate of adjuvant therapy delay between insurance types (e.g. Medicaid, Medicare, private insurance). All-cause mortality was higher in patients with adjuvant therapy delay (32.8% vs. 18.2%).

Conclusions: Adherence rate to timely adjuvant therapy was low at our institution, but patients with lower socioeconomic status are at even higher risk of adjuvant therapy delay and likely higher mortality rates.