Background: Despite universal healthcare in Canada, lower SES has been associated with worse survival in oral cavity squamous cell cancer patients (OCSCC). The relationship between SES and acute post-operative outcomes is currently poorly defined. Hamilton, Ontario presents a unique population with widely varying socioeconomic status within the same geographic region including a high proportion of lower socioeconomic status (SES) with higher rates of smoking and alcohol consumption.
Objectives: To study the relationship between SES, length of hospital stay (LOHS) and postoperative complications in OCSCC.
Methods: Newly diagnosed OCSCC patients receiving primary surgical treatment from 2010-2014 were identified from a prospectively collected database from the Hamilton’s regional cancer centre with a catchment of 2.3 million. Inclusion criteria included age >18 years old, pathological diagnosis of oral cavity cancer, primary surgical treatment with curative intent. Patients were excluded if they were undergoing palliative treatment or had previous head and neck surgery/radiotherapy. Postal codes were used to identify neighbourhood level socioeconomic variables via 2011 Canada Census, income quartiles were defined from groups of neighbouring municipalities based on Canada Census definitions. Demographic, social, pathological, staging, and treatment data were collected through chart review.
Results: One hundred and seventy four patients were included in the final analysis. OCSCC patients with lower SES were more likely to be younger (p=0.041), be male (p=0.040), smoke (p<0.001), have higher pack year history (p<0.001), have lower levels of education (p<0.001), and have lower employment levels (p<0.001). Lower SES patients had higher cT (p=0.006) and cN (p=0.004) staging and were more likely to receive adjuvant therapy (p<0.001). Lower SES score was associated with longer LOHS (p=0.003), Charlson comborbidity index (p=0.014), major and minor post-operative complications rates (p<0.001) and G-Tube rates (p<0.001). There were no statistical difference in marital status or Karnofsky score based on SES.
Conclusion: Patients with lower SES have more advanced OCSCC disease with increased comorbidities that owes itself to more acute post-operative complications and LOHS within our study population. Patients with low SES should be identified as patients that require more support during their treatment.