Patient-Reported Quality of Life and Socioeconomic Disadvantage Among Patients With Head and Neck Cancer

Importance: Lower socioeconomic status is a risk factor for poorer quality of life (QOL) among patients with head and neck cancer (HNC) after treatment; however, there is a paucity of literature describing baseline QOL in these patients, with much of the existing literature focused on financial characteristics rather than comprehensive, geographically based factors. Shifting focus to these factors could better capture the entire patient experience and allow clinicians to provide improved care. Objective: To examine the associations between area-level deprivation, a marker of socioeconomic disadvantage, and QOL among patients with HNC before treatment initiation. Design, Setting, and Participants: This cross-sectional single-institution study included patients diagnosed with HNC between 2015 and 2022 receiving care at a tertiary care center in a metropolitan setting who completed the Functional Assessment of Cancer Therapy-Head and Neck (FACT-HN) questionnaire before starting treatment. Data were analyzed between December 2024 and May 2025. Exposure: Area-level deprivation (measured using the area deprivation index ADI), as designated by the patient's respective ADI quintile, with the first quintile being the least deprived or socioeconomically disadvantaged and the fifth quintile being the most deprived or disadvantaged. Main Outcomes and Measures: FACT-HN domains of social, emotional, functional, physical, HNC-specific, and overall well-being or QOL. Multivariable linear regression models (1 for each domain) were used to estimate associations between ADI quintiles and FACT-HN domains, adjusting for patient and clinical characteristics. Results: A total of 600 patients (mean SD age, 62.5 11.4 years; 72.3% males n = 434) were included in the analysis. The ADI quintiles were equally distributed, with approximately 20% of patients in each quintile. Patients residing in the most disadvantaged areas reported lower HNC-specific well-being scores (β = -3.62; 95% CI, -6.23 to -1.01) compared with those residing in the least disadvantaged areas. Associations between ADI quintile and other well-being scores were weak and not clinically meaningful. Conclusions and Relevance: In this cross-sectional study, greater socioeconomic disadvantage is associated with poorer baseline QOL among patients diagnosed with HNC. These findings could be used to identify patients at higher risk of lower QOL and support the equitable allocation of resources from multidisciplinary cancer care teams.