Author(s)
John Vieth, BS
Anthony Mangino, PhD
Melina Windon, MD
Joseph Valentino, MD
Affiliation(s)
University of Kentucky College of Medicine
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to recognize factors associated with appointment noncompliance in patients with HPV related oropharyngeal squamous cell carcinoma (HPV-OPSCC).
Objectives: Our analysis of the HPV-OPSCC population's cancellation and no show rates are significantly higher than our institutional rates. Identifying demographic and clinical predictors for increased risk of missed appointments is the first step in designing interventions to avoid delays in care affecting therapeutic outcomes.
Study Design: Retrospective review of appointment data from an academic medical center.
Methods: All patients 18 years of age or older with p16-positive HPV-OPSCC who scheduled appointments between January 1, 2013, and April 1, 2023, were included. Appointment level data (show, no show, cancellation), clinical variables (tumor stage, site), and demographic variables (age, sex, race, ethnicity, smoker status, insurance type) were analyzed. Primary outcome was noncompliance, defined as no show without cancellation.
Results: Across 36,579 encounters in 334 p16-positive HPV-OPSCC patients, the no show rate was 4.6% (n = 1,627) and the cancellation rate was 31.0% (n = 11,081). Multivariable generalized estimating equations identified younger age (p < 0.001), African American/Black race (p = 0.009), tonsillar tumor location (p = 0.001), undefined tumor stage (p = 0.005), and public insurance type (Medicaid: p < 0.001; Medicare Advantage: p = 0.029) as significant predictors of appointment non-compliance. Results were consistent across unadjusted and adjusted analyses.
Conclusions: Specific subgroups have increased risk for noncompliance. Sociodemographic and disease specific factors may contribute to gaps in continuity of care. Efforts to reduce disparities in appointment adherence may reduce treatment delays and enhance outcomes in patients with HPV-OPSCC.