Abstract Background Although adjuvant treatments are preferred to begin within 6 weeks after surgery for patients with head and neck cancer, both the National Comprehensive Cancer Network guideline and ongoing cooperative group phase III clinical trials, such as NRG HN009, do not current specify when definitive treatments should start after the initial diagnosis of head and neck cancer. In addition, patients have various levels of healthcare access based on their health insurance among other social determinants of health. We performed an observational cohort study to evaluate whether treatments delays are associated with types of health insurance and clinical outcomes among patients with head and neck cancer receiving definitive radiation or chemoradiation. Methods Our single institution database was queried for patients with non-metastatic head and neck cancer diagnosed between October 2011 and December 2023 who received definitive radiation or chemoradiation. In addition to clinically relevant variables, primary health insurance and the dates of initial diagnosis and first radiation treatment were available for analysis. Those with induction systemic therapies, surgery, or palliative-intent treatments were excluded. Treatment delays were defined as more than 8 weeks between the initial diagnosis and the first radiation treatment. Cox multivariable analysis (MVA) and Fine-Gray MVA were performed for survival and tumor recurrence outcomes, respectively. Propensity score matching was also performed to reduce selection bias. Logistic MVA was used to identify variables associated with treatment delays. Results A total of 694 patients met our criteria. Of these patients, 302 patients (43.5%) had treatment delays. Median duration between the initial diagnosis and the first radiation treatment was 54 days (interquartile range 41-68). Median follow up was 46.8 months (95% confidence interval CI 45.5-49.2). Compared to those without treatment delays, patients with treatment delays had worse overall survival (OS; adjusted hazards ratio aHR 1.36, 95% CI 1.01-1.84, p=0.04), but not progression-free survival (PFS; aHR 1.15, 95% CI 0.88-1.50, p=0.31), locoregional failure (LRF; aHR 1.02, 95% CI 0.59-1.75, p=0.94), or distant failure (DF; aHR 0.75, 95% CI 0.45-1.24, p=0.26). Similar findings were noted among 274 matched pairs (OS: HR 1.43, 95% CI 1.03-1.98, p=0.03; PFS: HR 1.18, 95% CI 0.89-1.58, p=0.25; LRF: HR 1.20, 95% CI 0.65-2.22, p=0.56; DF: HR 0.85, 95% CI 0.52-1.38, p=0.51). On logistic MVA, Medicaid insurance was the only variable associated with treatment delays (vs private insurance; adjusted odds ratio aOR 2.35, 95% CI 1.41-3.94, p=0.001). Conclusion Our study suggested that nearly half of patients had treatment delays and that treatment delays were an independent, adverse prognostic factor for survival outcomes. It also suggested that those with Medicaid insurance were more likely to experience treatment delays than others with private insurance. Citation Format: Alec Kotler, Matthew Nguyen, Sung Jun Ma, Wayne Rutherford, Melissa Moore, Kevin Agner, Darien Reed, Jacob Wells, Om Desai, Frida Calderon Gutierrez, Krithik Tella, Daniel Alvarez, Andrew Koempel, Simeng Zhu, Priyanka Bhateja, Emile Gogineni, Sujith Baliga, David Konieczkowski, Darrion Mitchell, Sachin Jhawar, John Grecula, Matthew Old, James Rocco, Marcelo Bonomi, Lauren Miller, Dukagjin Blakaj. Association of treatment delays with health insurance and clinical outcomes among patients with head and neck cancer receiving definitive treatments abstract. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr A143.
Kotler et al. (Thu,) studied this question.
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