(26) Variabilities in Access to Specialty Care for Surgical Timing in Head and Neck Cancer Patients

Abstract:

Objectives: Free-flap reconstruction is the gold standard for reconstruction after resection of advanced head and neck (H&N) cancer. Sociodemographic factors often influence delayed diagnosis and access to specialty care. This study aims to investigate the association of race, insurance coverage, and statewide social vulnerability index (SVI) on the timing of patients receiving H&N reconstruction at one tertiary care center.

Methods: A retrospective chart review was conducted for patients with H&N cancer who underwent oncologic resection with oral surgery, with or without subsequent free flap reconstruction by plastic surgery at a tertiary care center from 2016 to 2024. Patients were divided into sociodemographic cohorts based on race (White, African American, Unknown/Other), insurance status (government, private, uninsured), and SVI quartiles: Q1 (0-25th percentile, least vulnerable), Q2 (26-50th percentile), Q3 (51-75th percentile), Q4 (76-100th percentile, most vulnerable). Days between symptomatic onset, initial encounter, and reconstructive surgery were compared between cohorts using ANOVA tests for multiple comparisons with post-hoc Tukey's HSD tests to assess significance (P < .05).

Results: There were 183 patients included for analysis. Majority of patients were White (71% vs African American: 23.5% vs Other: 5.5%), had government insurance (59.6% vs private: 32.2% vs uninsured: 8.2%), and were in the least vulnerable SVI (Q1: 32.8% vs Q2: 21.3% vs Q3: 23% vs Q4: 21.9%). The most vulnerable patients in SVI experienced longer delays from symptomatic onset to initial encounter when compared to those in lesser vulnerable SVI quartiles (Q4 = 345.35d, Q3 = 140.93d, Q2 = 177.66d; P < .05). Uninsured patients had a significantly longer delay from their initial tertiary care center encounter to reconstructive surgery compared to insured patients (uninsured = 59d, government = 34.1d, private = 28.03d; P < .05).

Conclusions: Socially vulnerable patients with H&N cancer experience delays in their initial presentation, potentially due to difficulties in accessing specialty care and transportation issues. Uninsured patients with H&N cancer face longer delays in scheduling surgery, possibly due to the financial burdens of self-payment for healthcare. These findings highlight the need for improved access and targeted interventions for at-risk groups with head and neck cancer in our center to deliver timely and equitable care.
Graphs for Race, Insurance and Social vulnerability index. Graph 4: All Cohorts and Mean days of symptom onset to initial encounter to surgery. Overall SVI in Mississippi