Factors associated with delays in treatment initiation and interruptions in head and neck squamous cell carcinoma: A retrospective single-institution analysis.

Abstract

e18115 Background: Timely initiation and uninterrupted delivery of curative-intent therapy are critical in head and neck squamous cell carcinoma (HNSCC). Despite guideline recommendations, real-world delays and treatment interruptions remain common and may adversely affect outcomes. We aimed to characterize treatment timelines, interruptions, and associated factors in patients with HNSCC at a safety-net hospital. Methods: We conducted a retrospective chart review of 58 patients with HNSCC treated with curative intent at University Health Truman Medical Center from 2019–2024. Demographic, clinical, insurance, and treatment timeline data were collected. Delayed treatment was defined as initiation >45 days from diagnosis; treatment interruptions were any unplanned pause in therapy. Results: Mean age was 58.5 years (range 34–80); 75.9% were male. Most presented with stage III–IV disease (81.4%). Mean time from diagnosis to first oncology consultation was 18.5 days, and mean time to treatment initiation was 87.5 days. Delays >45 days occurred in 62.1% of patients. Contributors included awaiting radiation consultation (17.2%), surgical coordination/metastatic work-up (13.8%), social barriers (housing insecurity, substance use; 8.6%), and insurance-related issues (6.9%). Treatment interruptions occurred in 32 patients (55.2%), median 1.5 interruptions among affected patients. Leading causes were treatment-related toxicity or hospitalization (59.4%), non-compliance (34.4%), insurance issues (15.6%), and social factors (substance use, housing insecurity; 9.4% each). Mean time to treatment initiation was shortest among privately insured patients (55.4 days) versus Medicaid/Medicare (93.0 days) and uninsured patients (87.4 days). Conclusions: Delays in treatment initiation and interruptions were common in this safety-net population. Insurance status, social determinants, and system-level coordination were key contributors. These findings highlight targets for interventions to improve timely and uninterrupted delivery of curative-intent therapy in patients with HNSCC.