Assessing barriers to adjuvant therapy among patients with head and neck cancer in Arkansas.

Advanced head and neck cancer (HNC) requires multimodal treatment and in the setting of primary curative intent surgery, adjuvant radiation with pathology-based chemotherapy is necessary for best outcomes. HNC treatment guidelines and best evidence support adjuvant radiation initiated within 6 weeks of surgery [1]. Over half of HNC patients face obstacles delaying adjuvant therapy, especially in rural areas [2]. This study assesses barriers to timely adjuvant therapy, specifically radiation in a rural tertiary setting. The study conducted was a retrospective mixed-methods analysis. The initial cohort consists of patients referred for adjuvant radiation therapy after curative intent head and neck surgery at a tertiary referral center, University of Arkansas for Medical Sciences, between 2020 and 2022. Demographic and socioeconomic data were collected and analyzed. Inclusion criteria for the study: patients referred for adjuvant therapy facing delays in treatment (> than 6 weeks) or deferring adjuvant treatment altogether. These patients and/or proxies were surveyed via telephone. Contact was made with 28 of the 46 patients meeting inclusion. 7 declined participation; 21 patients completed the survey personally, by proxy, or via family member. Among the respondents, the primary reasons for delaying adjuvant therapy include travel requirements/distance, general medical health, and financial constraints, with travel requirements/distance rated as the highest concern. Numerous obstacles to timely adjuvant therapy exist within our patient population. Understanding these barriers is crucial for improving timely access to adjuvant therapy and ultimately enhancing patient survivorship. Through individualized risk assessment, patient education, and resource management, we anticipate mitigating barriers to adjuvant therapy.