Access to surgery and high-quality radiotherapy for human papillomavirus related oropharynx cancer.

PURPOSE: De-escalation trials in human papillomavirus-associated oropharyngeal squamous cell carcinoma (HPV + OPSCC) have led to variable institutional treatment algorithms. It is unclear whether treatment options are offered equally throughout the United States. This study assesses how social determinants of health (SDOH), and treatment facility type impact access to surgery and/or high-quality radiotherapy (RT) for HPV + OPSCC.

RESULTS

Among 6,458 patients, the median age was 62, 93.1 % were White, and 79.2 % had no significant comorbidities. Patients with the highest education, income, and private insurance (p ≤ 0.002 for all) underwent more surgery. Patients with lower education and income presented with more advanced disease (each p < 0.001). Care at academic facilities was the strongest predictor of surgery for early-stage disease (aOR:6.17, 95 % CI:3.74-10.18, p < 0.001) and was more likely to result in a margin-negative resection (p = 0.017). Delays in TTI were highest among Black patients, uninsured patients, patients with low socioeconomic status (SES), and patients receiving care at academic facilities (p ≤ 0.011 for all). Patients with significant comorbidities were more likely to experience delays in TTA (p = 0.018) and TTC (p = 0.036). There were no differences in delays in TTA or TTC based on treatment facility.

CONCLUSIONS

SDOH affect access to surgery for HPV + OPSCC, with patients of low SES presenting with more advanced disease. Among early-stage cases, access to surgery is significantly greater at academic facilities, which offer superior surgical outcomes. Treatment completion times are comparable between academic and community facilities, suggesting that poor surgical candidates should pursue care at the facility offering the fastest treatment initiation and completion.