(0730) Socioeconomic Disadvantage Among Veterans with Head and Neck Cancer in Western Pennsylvania

Introduction: The National Comprehensive Cancer Network (NCCN) guidelines for post-treatment head and neck cancer (HNC) surveillance recommend frequent in-person clinic visits for physical and endoscopic exam. These guidelines place a significant financial and emotional burden on Veterans and disproportionately affect those in rural and disadvantaged communities. As a first step towards understanding the barriers to post-treatment surveillance in Veterans with HNC, we conducted a retrospective analysis on the socioeconomic disadvantage, travel burden, and rurality among Veterans with HNC in Western Pennsylvania.

Methods: Retrospective analysis of Veterans with HNC in Veterans Integrated Service Network (VISN)-4 was performed between years 2012 and 2022. Socioeconomic disadvantage was determined by Area Deprivation Index (ADI), ADI ranges from 1 (least deprived) to 100 (most deprived). Travel burden was determined by distance from the nearest complex Veterans Affairs Medical Center (VAMC) with subspecialty care. Rurality was determined by zip code utilizing the Rural Urban Continuum Area (RUCA) codes, which range from 1 (urban) to 9 (purely rural).

Results: A total of 4,068 Veterans with HNC in VISN 4 were identified in the ten-year time period. A majority (58%) of Veterans live in an area with an ADI of 60 or higher, signifying high socioeconomic disadvantage. Travel burden analysis revealed that 51% of Veterans travel greater than 393 miles round-trip to a VAMC specializing in HNC care. Rurality analysis demonstrated that 43% of Veterans were identified as RUCA class 1, whereas 16% were RUCA class 4 or above.

Conclusions: This exploratory analysis demonstrates that the majority of Veterans with HNC in VISN 4 live in areas of high socioeconomic disadvantage and travel great distances for HNC care. This places a significant logistical and financial burden on Veterans with HNC, likely affecting adherence to post-treatment HNC surveillance guidelines. Further investigation is warranted on how this socioeconomic burden may impact adherence and outcomes among Veterans with HNC.