Factors Associated With Time to Postoperative Radiation Therapy in Veterans With Head and Neck Cancer

OBJECTIVE: Initiation of postoperative radiation therapy (PORT) within 6 weeks of surgery for head and neck squamous cell carcinoma (HNSCC) is a National Comprehensive Cancer Network (NCCN) guideline and quality metric. However, guideline concordance in the Veteran population remains unknown. This study evaluates the effect of time to PORT on overall survival (OS) and factors associated with PORT delay among Veterans with HNSCC. STUDY DESIGN: This is a retrospective cohort study of Veterans with HNSCC. SETTING: Patients with HNSCC from 2012 to 2022, identified from the National Veteran's Affairs Database, were included. METHODS: Data were extracted for clinical/demographics, tobacco/alcohol use, area deprivation index, Elixhauser score, body mass index, rurality, travel distance, and location of radiation. Analyses conducted were bivariate comparisons via chi-square and Wilcoxon rank-sum test, as well as adjusted survival analyses and adjusted multivariable logistic regression modeling. RESULTS: Among 2719 HNSCC Veterans who received surgery and adjuvant radiation nationwide, 1638 (60.2%) received PORT within 6 weeks of surgery. On multivariable analysis, factors associated with PORT delay greater than 6 weeks included being unmarried (P = .0275), having an oral cavity primary subsite (P < .0001), and undergoing surgery at the VA and radiation in the community (P < .0001). Three-year OS was higher among those who received PORT within 6 weeks (70.2%) compared to those who received PORT greater than 6 weeks postoperatively (62.1%, P < .001). CONCLUSION: Veterans with HNSCC receive guideline-concordant PORT at a rate of 60.2%. Being unmarried, having oral cavity cancer, and community radiation were associated with PORT delay.