Timely surgical intervention for head and neck cancer (HNC) is critical to improving survival, particularly in advanced-stage disease requiring free-flap reconstruction. In medically underserved states, structural barriers such as rurality, socioeconomic disadvantage, and limited specialty availability can delay care. This study evaluates how race, insurance status, Social Vulnerability Index (SVI), and geographic distance affect delays in HNC surgical treatment in a state with the poorest national health outcomes and only one tertiary referral center.

A retrospective cohort study was conducted at the University of Mississippi Medical Center, including all patients undergoing oncologic resection by oral and maxillofacial surgery and free-flap reconstruction by plastic surgery from January 2016 to July 2024. Demographics, tumor stage, insurance status, SVI, and driving distance were recorded. Care intervals were defined as the time from symptom onset to initial tertiary appointment (PreUMMC) and from initial appointment to surgery (PostUMMC).

Of 180 patients (62.2% male, 70.6% White, 23.9% Black), 60% had government insurance and 22.5% resided in SVI quartile 4. Median PreUMMC delay was 115 days (interquartile range [IQR]: 61–225), which was over three times longer than the PostUMMC median of 28 days (IQR: 20–39; p < 0.001). PreUMMC delays were longest for SVI 4 patients (203.5 days, p = 0.029) and correlated with driving distance (ρ = 0.213, p = 0.004). Black patients were more likely to reside in high-SVI areas and present with advanced-stage tumors (pT4, 46.5 vs. 24.8%, p = 0.029). No significant sociodemographic differences were observed in PostUMMC timing.

In Mississippi, disparities in HNC surgical timing occur predominantly before tertiary care access, reflecting the influence of geographic distance and social vulnerability. Once within the academic system, treatment timelines are equitable across groups. Addressing upstream barriers through targeted referral pathways, transportation solutions, and outreach to high-SVI communities is essential to improving timely surgical access.

Received: 20 August 2025

Accepted: 25 February 2026

Accepted Manuscript online:
03 March 2026

Article published online:
17 March 2026

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