Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Objective: National Cancer Institute (NCI)-designated cancer centers provide comprehensive, high-quality care. Although the utilization of NCI-designated cancer centers has been studied in breast, colorectal, lung, and prostate cancer, factors associated with NCI-designated cancer center utilization has yet to be explored in head and neck cancer (HNC).This analysis aims to determine the individual- and community-level sociodemographic factors associated with the use of an NCI-designated cancer center compared to a non-NCI center for radiation treatment among HNC survivors.
Methods: Survivors with squamous cell carcinoma (SCC) of the oral cavity, oropharynx, larynx, and other sites, who received adjuvant or definitive radiation treatment, and who were seen at our HNC survivorship clinic from 2017 to 2022 were included. Survivors with recurrence, second primary, and/or distant metastasis were excluded. Clinical and sociodemographic factors including age, gender, race, marital status, insurance, employment, health literacy, national area deprivation index (ADI), rural-urban continuum codes (RUCC), and distance (miles) were collected. The probability of undergoing radiation treatment at an NCI-designated cancer center was analyzed using logistic regression models.
Results: In total, 313 survivors were included in the analysis. 188 survivors (60.1%) underwent radiation treatment at an NCI-designated cancer center and 125 survivors (39.9%) underwent radiation treatment at a non-NCI center. Most survivors were male (241, 77.0%) and White (277, 88.5%), with a mean (SD) age of 61 (10.0) years old, with oropharyngeal (167, 53.4%) and oral cavity (63, 20.1%) advanced stage III/IV (191, 61.0%) SCC. The odds of Black survivors receiving radiation treatment at an NCI-designated cancer center was 16.8 times the odds of White survivors (95% CI [3.46, 303.25], p=0.006). The odds of survivors who did not have insurance receiving radiation treatment at an NCI-designated cancer center was 71% less than survivors with private or Medicare insurance (95% CI [0.08, 0.92], p=0.046). For every 1-point increase in ADI, indicating residing in a more deprived area, the odds of receiving radiation treatment at an NCI-designated cancer center decreased by 1.0% (95% CI [0.98, 1.00], p=0.048). For every 1-unit increase in RUCC, indicating residing in a more rural area, the odds of receiving radiation treatment at an NCI-designated cancer center decreased by 22.0% (95% CI [0.67, 0.90], p<0.001). For every 1-mile increase in distance, the odds of receiving radiation treatment at an NCI-designated cancer center decreased by 2.0% (95% CI [0.97, 0.98], p<0.001).
Conclusion: Race, insurance type, neighborhood deprivation, rurality, and distance are predictors of NCI-designated cancer center utilization for radiation treatment in HNC. Future research should focus on developing interventions to mitigate disparities in NCI-designated cancer center utilization and to increase access to comprehensive, high-quality care in HNC. Furthermore, greater support for radiation clinics in under-resourced settings, especially deprived and rural communities, is needed to advance equitable care.