Delayed time to treatment initiation among patients with HPV-associated oropharyngeal squamous cell carcinoma, 2011–2024.

Abstract

e18091 Background: Delays in time to treatment initiation (TTI) has been shown to have a negative impact on cancer outcomes. We evaluated factors associated with delayed TTI among patients with HPV-associated oropharyngeal squamous cell carcinoma (OPSCC), a population with generally favorable outcomes with appropriate and timely treatment. Methods: Study data was derived from the Hutchinson Institute for Cancer Outcomes Research (HICOR) data repository, which links Western Washington (WA) SEER records, WA State Cancer Registry, and insurance claims data from the major payers in WA state (Regence, Premera, Medicare, Medicaid). We identified patients diagnosed with OPSCC between 2011 and 2024 who were positive for p16 or high-risk HPV by ISH. Eligible patients were adults 18 years and older, with primary cancer site involving the oropharynx, and continuous insurance enrollment from diagnosis through 6 months after diagnosis or death. Patients with tumors outside the oropharynx based on ICD 10 codes and those with HPV negative disease were excluded. TTI, defined as days elapsed between diagnosis and date of first treatment (radiation, chemotherapy, or surgery), was determined for all patients who received treatment; patients who had TTI > 60 days were considered to have delayed TTI. Descriptive statistics were used to characterize the study population. A multivariable logistic regression was used to identify factors associated with delayed TTI (>60 days). Results: Among HPV-positive patients (n=1019), the majority were male (87.3%), White (90.3%), aged 65 years and older (53.6%), on Medicare coverage (40.9%), with the tonsils as the most common primary tumor site (46%). Overall, 20.9% of patients with HPV positive OPSCC experienced delayed TTI. Among patients with delayed TTI, about 34.3% were Medicaid enrollees compared with commercial (17.7%), Medicare (20.1%), and those with multiple payers (17.9%) (p<0.001). Despite a disproportionately large White population, delayed TTI was higher among other races (31.2%) compared to White patients (19.9%) (p=0.011). In the multivariable model, Medicaid coverage remained independently associated with delayed TTI compared to patients on commercial insurance (adjusted OR 2.47, 95% CI 1.52–4.00, p<0.001). Other covariates including sex, age, cancer stage, area deprivation index, and rural/urban residence were not statistically significant. Conclusions: In this HPV-associated OPSCC cohort (2011–2024), approximately 1 in 5 patients experienced TTI >60 days. Insurance type—particularly Medicaid coverage—was the dominant predictor of delayed TTI after adjustment, suggesting persistent access barriers. This disparity in TTI uncovered in our study – impacting Medicaid patients – presents a unique opportunity for targeted interventions to improve care quality and outcomes among HPV OPSCC patients.