The double jeopardy effect of socioeconomic barriers on guideline-concordant postoperative radiation in oropharyngeal cancer.

Receipt of timely adjuvant radiation after primary surgery for head and neck cancer is a well-established quality benchmark. The social and structural drivers of suboptimal care, however, remain incompletely characterized. Very little work has been done on understanding the combined and interacting effects of social determinants on postoperative radiation therapy (PORT) receipt and timing. Upon examining PORT delivery among intermediate- and high-risk oropharyngeal squamous cell carcinoma patients, we identified that patients who are both uninsured and live far from a treatment center are at the highest risk for not receiving adjuvant radiation therapy. By identifying which specific patient subpopulations are most vulnerable to delayed or omitted treatment, this analysis provides actionable data to guide institutional interventions, optimize resource allocation, and support advocacy efforts aimed at closing equity gaps in head and neck cancer care.