Association of Socioeconomic Factors and Immunotherapy in Cutaneous Squamous Cell Carcinoma of the Head and Neck

BACKGROUND: There is little data on the relationship between socioeconomic factors and immunotherapy in advanced cutaneous squamous cell carcinoma of the head and neck (cSCCHN). METHODS: Our study analyzed patients with Stage IV cSCCHN diagnosed between 2018-2026 using the EPIC Cosmos database. Socioeconomic status was measured based on the social vulnerability index (SVI) and corresponding themes. Immunotherapy receipt was evaluated with Robust Poisson models. RESULTS: A total of 1140 patients were identified with Stage IV cSCCHN, with 338 (29.6%) of whom received immunotherapy. Higher SVI was associated with a lower likelihood of receiving immunotherapy (incidence rate ratio = 0.96). Patients in the most vulnerable overall SVI quintile had a 29% lower rate of receiving immunotherapy compared to the least vulnerable quintile (p = 0.018). Participants' race/ethnicity, insurance status, and urbanicity were not significantly associated with immunotherapy receipt. CONCLUSION: Increased social vulnerability is associated with reduced likelihood of treatment with immunotherapy among patients with Stage IV cSCCHN.