What question did this study set out to answer?

This study aims to understand how sociodemographic factors influence delays in surgical treatment for head and neck cancer in an underserved state.

March 6, 2026Journal of Reconstructive Microsurgery0 citations

Sociodemographic Factors and Delays in Care for Patients Undergoing Treatment for Head and Neck Cancer in a Medically Underserved State

KPKendall C. Pitre RMRonald Rae McCall MNMason M. Nodurft

Key Points

This study aims to understand how sociodemographic factors influence delays in surgical treatment for head and neck cancer in an underserved state.
Conducted a retrospective cohort study at the University of Mississippi Medical Center.
Included patients needing oncologic resection and free-flap reconstruction from January 2016 to July 2024.
Recorded demographics, tumor stage, insurance status, social vulnerability index, and driving distance.
Defined care intervals from symptom onset to initial appointment and from initial appointment to surgery.
Median delay before initial tertiary appointment was 115 days; median delay after appointment to surgery was 28 days.
Patients from high social vulnerability index areas experienced the longest delays before receiving care.
Black patients were more likely to have advanced-stage tumors compared to White patients.
No significant differences in timing were found once patients accessed the academic system.

Abstract

Background Timely surgical intervention for head and neck cancer (HNC) is critical to improving survival, particularly in advanced-stage disease requiring free-flap reconstruction. In medically underserved states, structural barriers such as rurality, socioeconomic disadvantage, and limited specialty availability can delay care. This study evaluates how race, insurance status, Social Vulnerability Index (SVI), and geographic distance affect delays in HNC surgical treatment in a state with the poorest national health outcomes and only one tertiary referral center. Methods A retrospective cohort study was conducted at the University of Mississippi Medical Center, including all patients undergoing oncologic resection by oral and maxillofacial surgery and free-flap reconstruction by plastic surgery from January 2016 to July 2024. Demographics, tumor stage, insurance status, SVI, and driving distance were recorded. Care intervals were defined as the time from symptom onset to initial tertiary appointment (PreUMMC) and from initial appointment to surgery (PostUMMC). Results Of 180 patients (62.2% male, 70.6% White, 23.9% Black), 60% had government insurance and 22.5% resided in SVI quartile 4. Median PreUMMC delay was 115 days (IQR 61-225), which was over three times longer than the PostUMMC median of 28 days (IQR 20-39) (P<0.001). PreUMMC delays were longest for SVI 4 patients (203.5 days, P=0.029) and correlated with driving distance (ρ=0.213, P=0.004). Black patients were more likely to reside in high-SVI areas and present with advanced-stage tumors (pT4, 46.5% vs. 24.8%, P=0.029). No significant sociodemographic differences were observed in PostUMMC timing. Conclusion In Mississippi, disparities in HNC surgical timing occur predominantly before tertiary care access, reflecting the influence of geographic distance and social vulnerability. Once within the academic system, treatment timelines are equitable across groups. Addressing upstream barriers through targeted referral pathways, transportation solutions, and outreach to high-SVI communities is essential to improving timely surgical access.

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