Disparities in supportive therapy for head and neck cancer and impact on missed radiation days and weight loss.

Abstract

6077 Background: National guidelines emphasize the importance of speech and swallowing (SS) and nutrition services (NS) for head and neck cancer patients (pts). This study evaluates influences of demographic and treatment factors on receipt of SS and NS at a safety-net hospital (SH) and an adjacent private hospital (PH). It also examines associations between lack of these services and negative outcomes. Methods: This retrospective analysis included non-metastatic laryngeal or oropharyngeal cancer pts treated with radiotherapy (RT) at a PH or SH. Univariate (UVA) and multivariable (MVA) analyses utilized linear regression, logistic regression, and zero-inflated Poisson regression. Covariates included race, ethnicity, preferred language, insurance status, immigration status, gender, age, treating hospital, comorbidity score, primary treatment modalities, time to treatment initiation (TTI), and stage. Potential negative outcomes of not receiving SS and/or NS were analyzed only among pts treated with chemoradiation (CRT). Results: Of 239 pts (PH = 138 pts; SH = 56 pts), 28.6% of SH pts received SS pre-RT vs 54.1% at the PH (p < 0.001). Receipt of pre-RT NS did not differ significantly between SH (14.3%) and PH (19.7%) but was low at both. On MVA, SH care (OR 0.29; p = 0.029) and longer TTI (OR 0.99; p = 0.033) were associated with decreased pre-RT SS. In contrast, surgery before RT (OR 10.1; p = 0.002) and surgery before CRT (OR 10.7; p = 0.001) vs RT alone were associated with increased pre-RT SS. No covariates were significantly associated with receipt of NS on MVA. For pts receiving CRT, pre-RT SS was associated with less weight loss during RT (mean difference = 2%; p = 0.036). Receiving both pre-RT SS and NS was associated with fewer missed RT days (RR 0.49; p = 0.004). Receipt of SS and/or NS were not associated with gastric tube placement, emergency room visits, or non-chemotherapy admission days during or within 90 days of CRT. Conclusions: SS was received less often at a SH vs a PH. NS were delivered at a low level at both centers. Lack of supportive services was associated with increased missed RT days and increased weight loss during CRT. Quality metrics to establish supportive care benchmarks may help reduce disparities.