Rurality of Residence Associated with Initial Stage of Oral Cavity and Oropharyngeal Squamous Cell Carcinoma

Tuesday, October 14, 2025

10:18 AM - 10:24 AM EDT

Location: 128

Disclosure(s):

Tony D. Satroplus, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Barriers to healthcare have been associated with poor outcomes in patients with cancer. The role rurality may play on stage of oral cavity or oropharyngeal cancer at initial presentation in a large sample study remains unstudied in the United States. This study includes the largest sample size in a United States study aimed at better understanding if rurality of patients’ residences is associated with the stage of oral cavity or oropharyngeal squamous cell carcinoma (SCC) at initial presentation.

Methods: This 2024 hospital-based multicenter retrospective observational review utilized the National Cancer Database (NCDB). Included patients were those diagnosed with SCC of the oral cavity or oropharynx from 2018-2021. Rurality of each patient’s residence which was based on the United States Department of Agriculture’s Rural-Urban Continuum Codes which were binned into Metro, Urban, and Rural. The main outcome of this study was AJCC 8th Edition clinical stage assigned to patient at initial presentation. All models were adjusted for year of initial presentation.

Results: A total sample of 42,258 patients was evaluated, including 43.2% (n=18,262) with oral cavity and 56.8% (n=23,996) with oropharyngeal SCC diagnoses. Patients with oropharyngeal SCC from urban areas had higher odds of having a Stage 3/4 cancer (AOR = 1.16; 95% CI: 1.05, 1.28) relative to metro patients. Participants from urban areas had an increased risk of death for both the oral cavity SCC group (AHR = 1.11; 95% CI: 1.01, 1.21) and oropharyngeal SCC group (AHR = 1.23; 95% CI: 1.10, 1.37) compared to patients residing in metro areas.

Conclusions: Urban patients were more likely to have a higher stage of oropharyngeal SCC at initial presentation, along with worse survival for either type of SCC, compared to the metro groups. Contrary to our initial hypothesis, rural outcomes did not statistically differ from metropolitan outcomes. Future local or regional database analyses would better characterize the more nuanced patterns present in a particular area, guiding clinical decisions including where to aim education and outreach efforts.

Presenting Author(s)

Tony D. Satroplus, MD

Resident
University of Nebraska Medical Center, Department of Otolaryngology
Omaha, NE, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

Steven C. Goicoechea, MD

House Officer
University of Nebraska Medical Center, Department of Otolaryngology-Head and Neck Surgery
Omaha, Nebraska, United States

Disclosure information not submitted.
KS

Kaeli Samson, MPH, MA

Statistician
Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, United States

Disclosure information not submitted.
MS

Makayla Schissel, MPH

Statistician
Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, United States

Disclosure information not submitted.
PL

Premila Leiphrakpam, MBBS

GME Patient Safety/Quality Improvement/Disparities Collaborative, College of Medicine, University of Nebraska Medical Center, United States

Disclosure information not submitted.
CA

Chandra Are, MBBS, MBBS, MBA, FSSO, FRCS, FACS

Professor
Department of Surgery, College of Medicine, University of Nebraska Medical Center, United States

Disclosure information not submitted.
EB

Elizabeth J. Bradford Bell, MD

Assistant Professor
University of Nebraska Medical Center, Department of Otolaryngology-Head and Neck Surgery
Omaha , NE, United States

Disclosure information not submitted.
TR

Tony Richa, MD

Assistant Professor
University of Nebraska Medical Center, Department of Otolaryngology
Omaha, NE, United States

Disclosure information not submitted.

Senior Author(s)

TR

Tony Richa, MD

Assistant Professor
University of Nebraska Medical Center, Department of Otolaryngology
Omaha, NE, United States

Disclosure information not submitted.