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5.74 days longer (95% CI Z 4.31-7.18, P < 0.001) than those with commercial insurance, 3.71 days longer (95% CI Z 2.10-5.31, P < 0.001) in patients from rural versus urban areas, 2.89 days longer (95% CI Z 1.08-4.70, P Z 0.002) in low versus high income areas, and 2.56 days longer (95% CI Z 0.79-4.33, P < 0.001) in regions with low versus high educational attainment. Conclusion: Prolonged package time in head and neck cancer has been previously shown to adversely affect survival outcomes. We identified significant national disparities in package time, particularly among patients with Medicaid insurance, low income and educational levels, and those living in more rural regions of the country. These findings provide a strong rationale for policy interventions intended to mitigate such delays in the timely completion of cancer therapy.

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