(A533) Delays in Adjuvant Therapy in Head and Neck Cancers: Identifying Clinical and Population Disparities

Introduction: Head and neck squamous cell carcinoma (HNSCC) treatment is multimodal, often requiring surgical resection followed by post-operative radiation therapy (PORT) or chemoradiation therapy (CRT), which the NCCN recommends initiating within 6 weeks after surgery. This study aims to identify factors contributing to delays in PORT/CRT initiation for HNSCC patients at single tertiary institution and to propose interventions to address this issue.

Methods: This is a retrospective review of 202 oral cavity HNSCC patients treated with surgical excision and PORT/CRT between 1/1/2013 and 1/1/2023. Delayed patients had more than 42 days between surgery and radiation initiation. We analyzed socioeconomic factors, pathology, surgical complexity and clinical course as potential causes of delay.

Results: Of 202 patients, 76.2% (n=154) experienced delays, with a mean 60.9±24.6-days between surgery and radiation therapy. There was a significant association between larger clinical tumor size (p=0.002), completing adjuvant therapy outside of the tertiary network (p=0.011), and frequent alcohol use (p=0.043) with delays to adjuvant therapy. There was a significantly longer time between surgery and the first RT consult for delayed patients (p < 0.0001). No difference was found among patient sex, employment status, smoking history, residence zip code, surgery type, or tumor stage.

Conclusions: This analysis highlights intrinsic and systemic barriers to timely PORT for oral cavity HNSCC patients, with 76.2% experiencing delays that risk poorer outcomes. Significant factors, such as larger tumors, receiving therapy outside Froedtert, and frequent alcohol use, point to challenges in surgical recovery, care coordination and lifestyle factors. The lack of association with sex, employment, smoking, residence, surgery type, or stage narrows the focus to modifiable barriers, emphasizing the need for targeted interventions to improve equity and outcomes.