Impact of Socioeconomic Status on the Uptake of Head and Neck Cancer Innovations

Introduction: Innovations have emerged for the treatment of head and neck cancer (HNC), meanwhile, dramatic disparities in outcomes by sociodemographic groups persist. This study aims to evaluate whether socioeconomic status (SES) plays a factor in the rate of uptake of three major recent HNC innovations.

Methods: National Cancer Database (NCDB) was utilized to obtain a cohort of adult patients with non-metastatic mucosal SCC between 2004 and 2021. Sub-cohorts were created based on the HNC innovation of interest. Addition of chemotherapy to high-risk PORT inclusion: surgical treatment, radiation treatment given after surgery, and extranodal extension or positive margins. Multimodality treatment for advanced stage inclusion: stage III-IV. TORS inclusion: oropharynx, T1-T2, N0-N1, and 2010+. Patients were categorized into low SES if they had any of the following variables: black or unknown race, Hispanic ethnicity, Medicaid or uninsured, and rural county of residence. Logistic regression modeling including an interaction term between year and SES were used to assess the crude and adjusted rate of increase in the proportion of each cohort receiving the innovation during the period of uptake.

Results: There was similar increase in the of the rate of chemotherapy during PORT in high-risk patients between groups on the adjusted model (low SES: 1.94 [95% CI: 1.60-2.29]; high SES: 1.57 [95% CI: 1.35-1.78]). There was a similar small increase in the rate of multimodality treatment for advance stages of disease between groups on the adjusted model (low SES: 0.48 [95% CI: 0.37-0.60]; high SES: 0.37 [95% CI: 0.29-0.44]). On the adjusted model, only the low SES had a significant increase in TORS over the study period, but this did not statistically differ from the high SES group (low SES: 1.04 [95% CI: 0.25-1.83]; high SES: 0.38 [95% CI: -0.01-0.76]).

Conclusions: While there are variations in the crude uptake trends of HNC innovations with those of lower SES, these differences were accounted for by other variables within the adjusted models. Overall, those with low SES did not have a lower rate of uptake of these recent HNC innovations.