The Daily Reflector. By Yushan Xie.

Cancer patients face an unforgiving clock. Every week of delay before starting treatment can increase the risk of death. Yet across North Carolina and much of the country, many patients wait, not because of oncology backlogs, but because they cannot get a timely dental appointment.

As a dental student working with head and neck cancer patients through the NC Schweitzer Fellowship, I have witnessed these delays up close. Therefore, my project partner and I aim to accelerate dental clearance for cancer patients in eastern North Carolina so they can begin treatment earlier and avoid preventable complications.

Before chemotherapy or radiation, especially to the head and neck, patients need a thorough dental evaluation to remove infection risks, known as the dental clearance. Radiation can compromise healing for life. A small untreated infection today can become osteoradionecrosis or a life-threatening complication later. Dental clearance is not an optional extra step; it is an essential part of safe cancer treatment.

In North Carolina, however, dental clearance exists in a policy gray zone. A 2021 law requires coverage of medically necessary dental care for cancer patients, and Medicaid provides some dental benefits. But coverage does not guarantee access.

Fewer than half of North Carolina dentists accept Medicaid, private plans differ on what counts as “medically necessary,” and there is no statewide timeline for timely clearance. Furthermore, eastern North Carolina has only one oral medicine specialist through ECU School of Dental Medicine, and she is the mentor for our project. As a result, care may be covered on paper, but in practice, it remains out of reach for many.

These access issues mirror troubling cancer trends. According to the National Cancer Institute, rural areas such as Eastern North Carolina have the highest rates of oral cavity and pharynx cancers. In North Carolina, 66.4% of these cancers are diagnosed at a late stage — higher than the national average of 63.7%. And treatment delays matter: NIH data show that delays of more than four weeks are linked to significantly worse survival outcomes. Every additional barrier, each referral loop, insurance denial, or clinic backlog, translates into real harm.

These delays fall heaviest on underserved communities. Rural patients face severe provider shortages. Medicaid patients struggle to find an in-network dentist. Patients without reliable transportation must weigh the cost of missing work for multiple appointments. When the system is stretched thin, the most vulnerable patients are the ones who wait the longest.

Fortunately, the solutions are practical and within reach. Hospitals and oncology centers can partner with dental providers to establish rapid-access pathways for pre-treatment evaluations. States can strengthen Medicaid reimbursement for medically necessary dental services to improve dentist participation. Dental schools can reserve referral slots for urgent oncology cases and integrate students into cancer care teams. Tele-dentistry can help triage simpler cases and reduce unnecessary visits.

These are not radical ideas. They are common-sense steps that treat dental care as a core part of healthcare, not a separate system that cancer patients must navigate alone.

Cancer does not wait, and neither should patients. Integrating dental access into cancer care pathways is not just compassionate policy, it is evidence-based, cost-effective, and lifesaving. Most importantly, it gives patients what they deserve: a fighting chance without unnecessary delay.

Yushan Xie is a 2025-26 ECU Health Schweitzer Fellow and a member of the East Carolina University School of Dental Medicine’s Class of 2027. The opinions expressed are the author’s own.