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Geographic Distance From A Tertiary Care Center Effects Timing Of Reconstruction In Head And Neck Cancer Patients
Sara E. Islam, MD, Kendall Pitre, BS, Ronald McCall, MS, John Phillips, BA, Ignacio Velasco, DDS, Soheil Vahdani, DDS, Benjamin McIntyre, MD, Laura S. Humphries, MD.
University of Mississippi Medical Center, Jackson, MS, USA.
Purpose: Advanced head and neck (H&N) cancers often require reconstruction using microsurgical free flaps following resection. Treatment access may be limited, particularly for patients in rural areas. This study investigates the impact of race, insurance status, social vulnerability index (SVI), and geographic distance to Mississippi’s only academic center on H&N reconstruction outcomes.
Methods: A retrospective chart review was conducted from 2016 to 2024 for patients with H&N cancer undergoing free flap reconstruction at the University of Mississippi Medical Center (UMMC). Cohorts were classified by race, insurance status, and SVI. Key metrics, including time from symptom onset to initial appointment and from initial appointment to surgery, were collected. Driving distance from patients’ homes to UMMC was analyzed across cohorts. Statistical analysis employed T-tests and ANOVA with post-hoc Tukey’s HSD tests.
Results: Seventy-three patients were included, with 68.5% male, 68.1% in the most vulnerable SVI quartile, 67.1% white, and 56.2% with government insurance. The average driving distance was 84.0 miles, taking 87.8 minutes. No significant differences in travel distance or time were observed based on insurance or race. However, ANOVA revealed that patients in the 3rd and 4th SVI quartiles faced significantly longer travel times (p<0.001). Additionally, both timeframes (symptom onset to appointment and appointment to surgery) correlated significantly with increasing travel distance (p<0.001).
Conclusions: Patients with H&N cancer are particularly vulnerable, and geographic distance significantly delays access to timely care. Addressing these physical barriers is essential for optimizing reconstruction outcomes in tertiary care centers.
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