Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Importance: Head and neck cancer (HNC) recurrence is common and portends worse prognosis than primary tumors. Clinical factors predicting HNC recurrence are well-documented. Social factors may influence these clinical factors, such as access to care delaying stage at presentation and time to treatment. However, the direct role of sociodemographic factors in predicting HNC recurrence remains poorly understood. Further characterization of sociodemographic predictors of HNC recurrence may inform monitoring and surveillance strategies in socially high-risk patients.
Objective: This study aims to identify sociodemographic characteristics associated with HNC recurrence at a tertiary academic medical center.
Design, Setting, and Participants: We conducted a prospective cohort study of mucosal HNC patients seen at our institution’s clinic. Participants completed validated questionnaires assessing health literacy and social support at the time of diagnosis. Primary outcome was the presence or absence of recurrence at any point after initial presentation with a minimum of two years of follow up data.
Main Outcomes and Measures: Primary outcome was recurrence within two years of treatment completion. Measures of interest included health literacy, social support, marital status, insurance status, employment, and clinically relevant variables.
Results: A total of 262 patients were included in analysis. Patients were mostly male (67.2%) with a median age at presentation of 63 (interquartile range [IQR] 56-70), and median follow up time of 40.6 months (IQR 30.5-40.8). The most common HNC subsite was oral cavity (50.0%). Recurrence was observed in 46 (17.6%) patients. Sociodemographic factors associated with recurrence on chi-square analysis included limited or marginal health literacy (p = 0.007, Cramer’s V = 0.17). Multivariable logistic regression revealed limited or marginal health literacy (odds ratio [OR] 2.57, 95% confidence interval [CI] 1.27 – 5.20; p = 0.009) and advanced stage at presentation (OR 2.82, 95% CI 1.40 – 5.68; p = 0.004) as independent predictors of HNC recurrence. To identify whether the relationship between health literacy and recurrence could be explained by time to treatment as an intermediate factor, mediation analysis was conducted and did not reveal a significant effect.
Conclusions and Relevance: Our findings indicate that low health literacy is associated with an increased risk of HNC recurrence. These patients may benefit from enhanced support and more frequent surveillance strategies to improve outcomes. This highlights the importance of integrating health literacy assessments into routine clinical practice for HNC patients.