Sociodemographic Predictors of Definitive Treatment in HPV-Positive Oropharyngeal Cancer: A Population- Based SEER Analysis

Introduction: Human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) is a distinct subset of head and neck cancers with favorable outcomes. However, the influence of sociodemographic factors on treatment recommendations remains unclear. This study aimed to examine sociodemographic disparities in the recommendation of chemoradiotherapy or radiotherapy (CRT/RT) as a definitive treatment versus other treatments.

Methods: A retrospective cohort analysis was performed using the Surveillance, Epidemiology, and End Results (SEER) database. Inclusion criteria comprised HPV-positive status between 2010-2017, complete clinical and demographic data, excluding patients with metastatic disease. Multivariable logistic regression was preformed, controlling for tumor primary site, AJCC 7th ed staging, age, race, sex, median household income, rural-urban status.

Results: Among 13,549 patients, significant disparities were identified in late-stage disease (AJCC III/IV). Black patients had higher odds of being recommended CRT/RT as a definitive treatment versus White (OR=1.50, 95% CI:1.24-1.81) and Hispanic (OR=1.35, 95% CI: 1.07-1.73) patients. Male sex (OR=1.21, 95% CI: 1.07-1.37) and metropolitan residence (OR=1.18, 95% CI: 1.03-1.35) also had higher odds of being recommended CRT/RT. Patients aged > 65 were more likely to be recommended CRT/RT compared to those < 45 (OR=1.95, 95% CI: 1.58-2.39) and 45–64 (OR=1.36, 95% CI: 1.24-1.49). Among early-stage (AJCC I/II) patients, age was the only significant predictor of receiving CRT/RT (P = 0.048), with a non-significant trend toward higher odds in those ≥65 (OR = 1.92, 95% CI: 0.98–3.74). Income was not significant at any AJCC stage.

Conclusions: Significant disparities exist in treatment recommendations for HPV-positive OPSCC, particularly in late- stage disease thus harming patient outcomes. Targeted Interventions are needed to promote equitable cancer care.