3596 - The Compounding Effects of Socioeconomic and Access Barriers on Guideline-Concordant Care for Oropharyngeal Squamous Cell Carcinoma
Presenter(s)
S. Ramanan1, G. Ashji2, Y. Wu3, E. C. Dee4, and N. Y. Lee4; 1Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, 2Rutgers New Jersey Medical School, Newark, NJ, 3Memorial Sloan Kettering Cancer Center, New York, NY, 4Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
Purpose/Objective(s): Among Oropharyngeal Squamous Cell Carcinoma (OPSCC) patients treated with primary surgery and clear pathologic indications for postoperative radiation therapy (PORT), we hypothesized that socioeconomic and access-related factors would reduce receipt of guideline-concordant adjuvant radiation, cause treatment delays, and interact synergistically to amplify disparities.
Materials/Methods: Retrospective analysis of NCDB OPSCC cases (2010-2021) identified 2,625 patients (age 18-79) with surgery-first treatment and PORT indications (high-risk: positive margins/ENE >1 mm and intermediate-risk: PNI/LVI/close margins/=4 nodes/ENE =1 mm). Multivariable logistic regression (N=2,329) assessed predictors of PORT receipt. Among recipients with timing data (N=1,907), factors for delay >8 weeks post-surgery were evaluated. Interaction model tested synergistic effects of insurance and travel distance =50 km on PORT receipt (N=2,625).
Results: PORT was received by 74.3% of patients overall, with significantly higher receipt in the high-risk pathology group (79.6%). Independent predictors of lower PORT receipt included Medicaid insurance (OR 0.73, 95% CI 0.55–0.97, p=0.027) and Medicare insurance (OR 0.76, 95% CI 0.59–0.99, p=0.039). On the other hand, high-risk pathology (OR 2.83, p<0.001) and HPV-positive status (OR 1.36, p=0.019) show increased receipt of PORT. Median time to PORT initiation was 51 days (IQR 35–77) with delays of greater than 8 weeks impacting Black and Hispanic patients the most. Medicaid and uninsured patients also saw the highest rates of delayed PORT initiation. Uninsured status and distance =50 km demonstrated significant synergistic interaction (OR 0.694, p<0.05) with predicted PORT receipt of 52.1% for uninsured patients living =50 km away.
Conclusion: Nearly one in four OPSCC patients with clear PORT indications fail to receive adjuvant radiation with insurance-related barriers being the primary driver. The synergistic interaction between lack of insurance and greater travel distance compounds marginalization and reduces receipt of guideline-concordant care beyond what would be expected from either factor alone. These findings highlight the need for targeted interventions such as insurance support, transportation assistance, and equity-focused care pathways in order to mitigate access barriers, improve timely delivery of PORT, and reduce survival disparities in this population.