For head and neck cancer patients who undergo surgery, the window between the operating room and the radiation suite is not merely administrative — it is prognostically decisive. In a healthcare system serving a population with disproportionately high tobacco exposure and social vulnerability, understanding what delays life-saving adjuvant therapy has direct implications for survivorship equity.
This retrospective cohort analysis drew on the National Veterans Affairs Database to examine 2,719 veterans with head and neck squamous cell carcinoma (HNSCC) who received both surgery and adjuvant radiation between 2012 and 2022. Roughly 60% initiated postoperative radiation therapy (PORT) within the NCCN-recommended six-week window. Three-year overall survival was meaningfully higher in the timely group — 70.2% versus a lower figure in those delayed — underscoring that guideline concordance carries measurable survival consequences. On multivariable logistic regression, three factors independently predicted PORT delay: unmarried marital status, oral cavity primary tumor subsite (likely reflecting more complex wound healing and reconstructive timelines), and a care-fragmentation pattern in which surgery occurred at a VA facility but radiation was delivered in the community.
The care-fragmentation finding is particularly important from a systems perspective. Split-system care — a known structural feature of VA community care expansion policies — introduces coordination gaps that can erode the benefits of otherwise high-quality individual treatment components. Oral cavity subsites present additional biological plausibility for delay given the prevalence of free-flap reconstruction, which requires healing time before radiation can safely begin. Marital status as a predictor likely serves as a proxy for social support and care navigation capacity, consistent with extensive oncology literature linking social isolation to worse treatment adherence and outcomes. Key limitations include the retrospective design, potential for residual confounding, and the possibility that some delays were clinically indicated rather than avoidable. Nonetheless, the dataset's scale and the survival signal make this an actionable finding for VA oncology coordinators seeking to reduce preventable mortality through targeted scheduling interventions.