Factors Associated with Surgery as Initial Treatment for Head and Neck Cancers at a Referral Hospital in the City of Rio de Janeiro

Abstract

Introduction: Surgery has a central role in the treatment of head and neck cancers (HNC). Inequalities in access to cancer care can impact the therapeutic plan. Objective: To identify factors associated with surgery as the first cancer treatment in patients with HNC treated at a referral hospital in the city of Rio de Janeiro. Method: Retrospective cohort study with data from patients diagnosed with HNC in 2024. The outcome was surgery as the first treatment. Sociodemographic, clinical, and healthcare context variables were analyzed. Chi-square or Fisher’s exact tests were used to compare outcome groups, alongside association tests and univariate and multivariate logistic regressions, with adjusted odds ratio (aOR) and 95% confidence intervals. Results: Of the 399 patients, 67.9% underwent surgery as initial treatment. The following groups had a lower likelihood of undergoing surgery: men (aOR=0.31; 95% CI: 0.17–0.54), and cases of nasopharyngeal and hypopharyngeal tumors (aOR=0.11; 95% CI: 0.00–0.67). A higher likelihood of initial surgical treatment was observed in patients with thyroid cancer (aOR=13.22; 95% CI: 4.95–42.49), eye and adnexal cancers (aOR=31.04; 95% CI: 5.78–580.79), larynx (aOR=4.02; 95% CI: 1.67–10.28) and malignant skin neoplasms (aOR=5.77; 95% CI: 2.71–13.07). There was no significant association with distance between residence and hospital. Conclusion: The definition of initial treatment in HNC is influenced by clinical and sociodemographic factors. Low likelihood of surgery in men and patients with oral and oropharynx cancer reinforces the necessity of strategies aimed at early diagnosis and reduction of inequalities of oncologic care in the National Health System.