UCSF

Objective

Limited literature focuses on delays in accessing head and neck cancer (HNC) care across the entire care continuum. This study aims to describe the time to care from symptom onset to treatment completion and identify predictors of delays for oral cavity cancer patients.

Methods

We reviewed patients with oral cavity squamous cell carcinoma (OCSCC) treated with curative surgery followed by adjuvant treatment at a tertiary center. Delays were defined per published thresholds for: time to treatment initiation (TTI, diagnosis to surgery), time to adjuvant treatment (stratified by whether adjuvant treatment was at the same or different facility as surgery), and total treatment package time. We also measured symptom duration, reported median times, and used logistic regression to assess predictors of delay.

Results

Among 93 patients, median (IQR) symptom duration was 17.4 weeks (IQR: 6.8-42.8); TTI 6.9 weeks (IQR: 4.4-10.4); time to adjuvant radiation 8.4 weeks (IQR: 7.4-9.3) at the same institution as surgery was performed and 9.3 weeks (IQR: 7.4-14) at a different facility; and total treatment package time 15.4 weeks (IQR: 12.6-20) for surgery and adjuvant radiation, and 16.3 weeks (IQR: 15-18.6) for surgery and adjuvant chemoradiation. 73% of patients experienced delays in reaching a healthcare facility, 39% in TTI, 89% in starting adjuvant treatment, and 64%-81% in total treatment time. In univariate analyses, late-stage disease, residing in a community with higher social vulnerability index (SVI), longer time from surgery to pathology report, need for free flap, and social worker interaction were associated with higher odds of delay in any care interval following diagnosis. Higher SVI was associated with delays in multivariate analyses.

Conclusion

HNC patients experience delays during all phases of cancer care. Interventions and future research need to address social determinants of health and health system factors that contribute to multifactorial delays across the care continuum.