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Program Number: B214
Session Name: Poster Session

Is Race or Socioeconomic Status Associated with Time to Surgical Treatment of Oral Cavity Cancer?

Kenneth D Newman; Claudia Gutierrez, MD; Elena Miller; Noah Thornton; Katherine Fedder, MD; Jonathan Garneau, MD; David Shonka, MD; Eric Dowling, MD; University of Virginia

Background: Cancer is the second leading cause of death in the United States, with oral cavity and oropharyngeal cancers comprising approximately 4% of cases in 2022, leading to over 11,000 deaths. Persistent health inequities—rooted in racial, socioeconomic, and geographic disparities—contribute to higher rates of undetected and late-stage cancers in vulnerable populations. Black and Hispanic men, for instance, have been found to be 42% less likely to be offered oral cancer surgery, and 38% more likely to refuse surgery.

Our study assesses treatment timelines and follow-up care for oral cavity cancer. Utilizing the Center for Disease Control’s (CDC) Social Vulnerability Index (SVI) to gauge patients’ socio-economic and demographic vulnerability, we investigate disparities in care based on SVI, race, and gender among patients evaluated at a single tertiary referral center.

Methods: Using the EPIC Slicer Dicer tool, we identified all oral cavity cancer patients treated surgically in the Head and Neck Department. We collected demographic data, including age, gender, race/ethnicity, and SVI. Clinical data included duration of symptoms prior to biopsy, time from initial Otolaryngological evaluation to surgery, time from biopsy to surgery, length of stay, and follow-up duration. Data was managed in REDcap, and statistical analyses were conducted using GraphPad software, employing ANOVA for SVI group comparisons and t-tests for gender and race/ethnicity groups.

Results: Our findings highlight significant disparities associated with SVI, race, and gender. Patients in the lowest SVI category (indicating lower vulnerability) had a statistically significant shorter follow-up period compared to those in the highest SVI category (p = 0.0005, Welch Corrected), as well as a significantly shorter time from biopsy to surgery (p = 0.04). This suggests that patients with lower vulnerability may have fewer barriers to accessing consistent post-operative care and faster surgical timelines.

Non-White patients demonstrated a trend toward longer hospital stays compared to White patients, averaging 6.3 days compared to 4.2 (p = 0.3), though this result was not statistically significant. This aligns with prior findings suggesting that non-White patients may face systemic delays in discharge, potentially due to barriers such as limited access to home health resources, language differences, or caregiver availability. Moreover, while female patients exhibited a longer average wait time from biopsy to surgery compared to male patients, no significant difference was found in the time from initial ENT evaluation to surgery, suggesting that the delay may occur in pre-surgical scheduling rather than in the surgical process itself.

Conclusion: Our study reinforces the presence of social and racial disparities in the treatment and follow-up care of patients with oral cavity cancer. Notably, patients with lower social vulnerability experience faster access to surgery and follow-up care, suggesting that higher vulnerability may correlate with systemic delays. Additionally, the extended hospital stays for non-White patients may reflect socio-economic and logistical challenges that complicate discharge, highlighting the need for focused preoperative planning and resource allocation. Addressing these disparities, including prioritizing follow-up for high-SVI patients and improving discharge processes for non-White patients, could enhance care equity and outcomes for all oral cavity cancer patients.

 

 

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