Impact of socioeconomic and demographic factors on treatment-related time intervals in oral cavity cancers: National Cancer Database study.

Abstract

e18122 Background: Oral cavity squamous cell carcinoma (OCSCC) has high mortality, recurrence, and metastasis, requiring multimodal treatment. Treatment delays reduce overall survival (OS), yet the role of socioeconomic factors, such as insurance status and facility type, in treatment intervals and survival, remains unclear. This study examines the impact of these factors on OS using the National Cancer Database (NCDB). Methods: Patients diagnosed with OCSCC were identified from the NCDB from 2004 to 2024. Demographic, socioeconomic, treatment, and survival data were extracted. Insurance status, a proxy for socioeconomic status, was categorized as private, uninsured, Medicaid, Medicare, or other government insurance. Inclusion criteria required patients to have undergone surgery and radiation, with complete data on malignancy type, vital status, and treatment intervals. Missing data and patients with unknown insurance status were excluded from this study. Cox Proportional Hazards models were used to assess the impact of socioeconomic factors on OS, adjusting for age, sex, race, tumor size, and time to surgery and radiation. Statistical significance was defined as p <0.05. Results: A total of 86,246 patients were included, contributing 309,952 person-years of follow-up and 21,425 events. The median OS was 3.02 years. Patients with private insurance had significantly better OS compared to those uninsured or with Medicaid, Medicare, or other government insurance ( p <0.05). Patients treated at comprehensive community cancer centers were associated with improved OS relative to patients treated at other facility types (HR= 0.94, 95% CI 0.88-1.01 p <0.05). Tumor size and delays in surgery and radiation were independently correlated with worse survival outcomes (Table 1). Conclusions: Socioeconomic factors, particularly insurance status and facility type, significantly impact survival in OCSCC. Treatment delays worsen disparities, highlighting the need for interventions to improve access and outcomes. Cox model of factors influencing overall survival in OCSCC. Variable Hazard Ratio [95% CI] p-value Uninsured 1.18 [1.09, 1.27] <0.001* Medicare 1.26 [1.20, 1.32] <0.001* Medicaid 1.06 [1.02, 1.10] 0.003 * Other Government Insurance 1.16 [1.06, 1.27] 0.001 * Age 1.10 [1.07, 1.12] <0.001* African American 1.03 [0.98, 1.09] 0.269 All Other Races 1.32 [1.25, 1.39] <0.001 * Female 1.08 [1.05, 1.11] <0.001* Diagnosis to Surgery (Days) 1.03 [1.01, 1.04] <0.001* Diagnosis to Radiation (Days) 1.03 [1.02, 1.04] <0.001* Tumor Size 2.84 [2.79, 2.89] <0.001* Community Cancer Program 1.36 [1.24, 1.50] <0.001* Comprehensive Community Cancer Program 0.94 [0.88, 1.01] 0.077 Academic/Research Program 1.07 [1.01, 1.14] 0.032 * Integrated Network Cancer Program 1.01 [0.94, 1.08] 0.840 *statistical significance.