Socioeconomic Disadvantage and Care Proximity Influence Stage at Presentation in Head and Neck Cancer

OBJECTIVE: To evaluate how patient circumstances that may influence access to care, including area deprivation index (ADI), distance to care center, and rural/urban status affect stage of presentation for HNSCC. STUDY DESIGN: Retrospective, single-institution study. SETTING: Urban, academic tertiary care center. METHODS: Patients with a history of HNSCC of the oral cavity, oropharynx, hypopharynx, larynx who presented to our institution between 2018 and 2023 were included. Demographic factors including age, race, sex, ADI, insurance status, distance to tertiary care center, and rural-urban continuum codes were collected. Primary outcome of interest was clinical stage at presentation. RESULTS: 1170 patients met inclusion criteria, of which 675 (57.7%) presented with early-stage disease and 495 (42.3%) presented with late-stage disease. On multivariable analysis, closer proximity to care center, insurance status, current or former smoking status, p16 negativity, and tumor subsite of the oral cavity or hypopharynx were associated with late-stage diagnosis. After sub-stratification for patients within the closest distance quartile, female sex, p16 negativity, non-white and non-black race, and insurance status remained associated with late-stage disease presentation. CONCLUSION: Patient characteristics often associated with socioeconomic disadvantage including minority race, Medicaid, or lack of insurance were associated with a later stage of presentation for HNSCC. Individuals living within the closest distance to our tertiary care center were more likely to present with late-stage disease, highlighting the need for improved access to care for socioeconomically disadvantaged urban populations.