Evaluation of Head and Neck Squamous Cell Carcinoma (HNSCC) Patient Outcomes Based on Rurality: A Retrospective Cohort Study.

Abstract

Introduction: Patients with head and neck squamous cell carcinoma (HNSCC) receiving chemoradiotherapy require ongoing treatment and follow-up, which may be influenced by distance to care. Rural patients often face limited access to specialized treatment centers, yet data on rurality's impact on compliance and outcomes remain limited. This study evaluates differences in treatment adherence and outcomes between rural and urban HNSCC patients.

Methods: Retrospective chart review identified patients with HNSCC treated with chemoradiotherapy from 2010-2019 at Sanford Health in Sioux Falls, South Dakota; Fargo, North Dakota; and Bismark, North Dakota. Patients were classified as either rural (R) or urban (U) based on their home address using the Federal Office of Rural Health Policy (FORHP) definition. Differences in patient and disease characteristics were analyzed. Post-treatment complications (ototoxicity, osteoradionecrosis, and treatment compliance (major delays in radiation treatment [greater than 5 days] and prolonged time to complete radiation [greater than 52 days]) were compared between groups using chi-squared and t-tests.

Results: 132 patients met eligibility. Participants were predominantly male (80% U, 83.1% R), Medicare/ Medicaid (66.2% R, 60% U), Oropharynx (57.1% R, 61.8% U), and stage IV (84.4% R, 85.5% U). There was no significant difference in number of missed appointments (p=0.16), treatment breaks (p=0.15), prolonged time to complete radiation (p=0.67). Post-treatment complication rates were also similar: ototoxicity (R: 51.9%, U: 58.2%, p=0.49), osteoradionecrosis (R: 16.9%, U: 7.3%, p=0.1), and soft tissue necrosis (R: 35.1%, U: 27.3%, p=0.34).

Conclusion: Rural and urban HNSCC patients showed no significant differences in treatment adherence or outcomes. These findings suggest that rural patients may have access to sufficient resources and support, enabling them to receive cancer treatment comparable to their urban counterparts. However, this study may be limited by its relatively small sample size, and further research is warranted to explore this topic in larger and more diverse populations.