(0662) Impact of Social Determinants of Health on Adjuvant Radiation Timeline in Head and Neck Cancers

Introduction: Social determinants of health can interfere with starting and completing postoperative adjuvant radiation therapy (PORT) for head and neck cancers within 6 weeks and 100 days of surgery respectively: a quality metric for cancer care set by the American College of Surgeons (ACS). We investigated how different social determinants of health affect one’s ability to initiate and/or complete PORT with the goal of identifying areas for potential targetable interventions to improve care equity.

Methods: A retrospective cohort study of Boston Medical Center head and neck cancer patients (n = 309) from February 2002-June 2019 was conducted. Demographic and disease-specific variables were recorded, including whether the patient started and completed PORT within 6 weeks and 100 days of surgery respectively. Data were analyzed using Welch’s t-test.

Results: Four patients taking longer than one year to finish radiation treatment were excluded as outliers. Patients who started adjuvant radiation within 6 weeks of surgery were more likely to complete adjuvant radiation within 100 days of surgery (p < 0.001). White patients were found to be more likely to complete radiation treatment within 100 days of surgery compared to Black patients (p = 0.006). Several other sociodemographic variables (gender, insurance, primary language, distance from hospital, and median household income) were also analyzed. However, they were not found to be statistically significant. Most patients within our study failed to meet the ACS guideline of completing radiation treatment within 100 days of surgery (58%).

Conclusions: White patients were found to be more likely to complete PORT within 100 days of surgery compared to Black patients. Additional research is necessary to understand the factors driving this inequity, as whether this disparity is provider-related, patient-related, or health system-related remains unknown. Furthermore, it’s important to explore more general barriers to care, independent of sociodemographic identifiers, as a majority of patients within our study failed to meet the ACS guidelines for PORT.