Assessing delays in laryngeal cancer treatment

Smith, Matthew; Abrol, Anish; Gardner, Glendon M.

doi:10.1002/lary.25734

Cited by 27 publications

(41 citation statements)

References 18 publications

(26 reference statements)

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“…97 Another study found that patients routinely delay medical evaluation of hoarseness symptoms for >100 days. 98 Prompt referral by primary care physicians could improve outcomes and QOL.…”

Section: Supporting Textmentioning

confidence: 99%

Clinical Practice Guideline: Hoarseness (Dysphonia) (Update)

Stachler

Francis

Schwartz

et al. 2018

Otolaryngol.--head neck surg.

236

204

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Objective. This guideline provides evidence-based recommendations on treating patients who present with dysphonia, which is characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication and/or quality of life. Dysphonia affects nearly one-third of the population at some point in its life. This guideline applies to all age groups evaluated in a setting where dysphonia would be identified or managed. It is intended for all clinicians who are likely to diagnose and treat patients with dysphonia.Purpose. The primary purpose of this guideline is to improve the quality of care for patients with dysphonia, based on current best evidence. Expert consensus to fill evidence gaps, when used, is explicitly stated and supported with a detailed evidence profile for transparency. Specific objectives of the guideline are to reduce inappropriate variations in care, produce optimal health outcomes, and minimize harm.For this guideline update, the American Academy of Otolaryngology-Head and Neck Surgery Foundation selected a panel representing the fields of advanced practice nursing, bronchoesophagology, consumer advocacy, family medicine, geriatric medicine, internal medicine, laryngology, neurology, otolaryngology-head and neck surgery, pediatrics, professional voice, pulmonology, and speech-language pathology.Action Statements. The guideline update group made strong recommendations for the following key action statements (KASs): (1) Clinicians should assess the patient with dysphonia by history and physical examination to identify factors where expedited laryngeal evaluation is indicated. These include, but are not limited to, recent surgical procedures involving the head, neck, or chest; recent endotracheal intubation; presence of concomitant neck mass; respiratory distress or stridor; history of tobacco abuse; and whether the patient is a professional voice user. (2) Clinicians should advocate voice therapy for patients with dysphonia from a cause amenable to voice therapy.The guideline update group made recommendations for the following KASs: (1) Clinicians should identify dysphonia in a patient with altered voice quality, pitch, loudness, or vocal effort that impairs communication or reduces quality of life (QOL). (2) Clinicians should assess the patient with dysphonia by history and physical examination for underlying causes of dysphonia and factors that modify management. (3) Clinicians should perform laryngoscopy, or refer to a clinician who can perform laryngoscopy, when dysphonia fails to resolve or improve within 4 weeks or irrespective of duration if a serious underlying cause is suspected. (4) Clinicians should perform diagnostic laryngoscopy, or refer to a clinician who can perform diagnostic laryngoscopy, before prescribing voice therapy and document/communicate the results to the speech-language pathologist (SLP). (5) Clinicians should advocate for surgery as a therapeutic option for patients with dysphonia with conditions amenable to surgical intervention, such as su...

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“…97 Another study found that patients routinely delay medical evaluation of hoarseness symptoms for >100 days. 98 Prompt referral by primary care physicians could improve outcomes and QOL.…”

Section: Supporting Textmentioning

confidence: 99%

Clinical Practice Guideline: Hoarseness (Dysphonia) (Update)

Stachler

Francis

Schwartz

et al. 2018

Otolaryngol.--head neck surg.

236

204

View full text Add to dashboard Cite

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“…In addition, smokers with lower risk of relapse and death in a 5-year period when compared with non-smokers, as we showed (only 4 in this study), could be explained by genetic and molecular alterations considered as a distinct pathological entity and leading to poor prognosis; thus, this fact needs more investigation. 13 14 Complementary, in the literature, more relapses are observed in smokers as genetic alterations remains in patients, even after quitting the habit, and the presence of concept of field cancerization in these subjects is very important . 15 16 Another factor is that most of the smokers do not quit the habit, which increases the rate of second primaries and decreases the OS.…”

Section: Discussionmentioning

confidence: 93%

Laryngeal Cancer Attributable Factors and the Influence on Survival Rates: A Single Brazilian Institution Experience

Innocentini

Teixeira

Casemiro

et al. 2019

Int Arch Otorhinolaryngol

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Introduction Epidemiological studies focused on prognostic factors associated with laryngeal cancer in the Brazilian population are poorly reported in the literature. Objective To evaluate the influence of certain risk factors on the survival rates of patients with squamous cell carcinoma (SCC) of the larynx. Methods This retrospective study was conducted on adult patients who were admitted to the outpatient clinic of the head and neck department in a tertiary care hospital. Evaluation of the influence of risk factors on the survival rates of patients registered in the hospital with laryngeal SCC was performed based on age, sex, initial stage, time of evolution, habits, educational levels and relapse and death. Overall survival (OS), disease-free survival (DFS) and clinical-demographic data were analyzed using the Kaplan-Meier method, Log-rank test and Cox regression. Results A total of 107 patients with a mean age of 59.8 years (range 19–81) were included in this study. Stages III and IV were associated with decreased DFS (p = 0.02) and OS (p = 0.02). Smoking patients had a greater period of disease evolution than non-smoking patients (p = 0.003). Alcohol consumption in smokers increased the risk of death by 2.8 (p = 0.002) compared with non-drinking smokers. Male patients presented lower DFS average when compared with female patients (p = 0.04). Conclusion Our study confirms that male gender, smoking habit combined with alcohol consumption, and advanced stages were strongly associated with poor prognosis.

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“…The former can be separated into patient-related delays-delays from the onset of symptoms to presentation to a physician-and professional delays-delays from presentation to diagnosis and treatment initiation. 14,15 Much of the work on delays during treatment have focused on interruptions during radiation therapy (RT), which are hypothesized to allow for proliferation of aggressive tumor clones. [16][17][18] Treatment times have been a subject of research in head and neck cancer (HNC), with a focus on the total length of treatment.…”

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confidence: 99%

Treatment Times in Salivary Gland Cancer: National Patterns and Association with Survival

Morse

Fujiwara

Judson

et al. 2018

Otolaryngol.--head neck surg.

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Objective To characterize treatment times in salivary cancer; associate treatment times with patient, tumor, and treatment characteristics; and examine the association of treatment times and overall survival. Study Design Retrospective cohort. Setting Commission-on-Cancer Accredited Hospitals 2004-2013. Subjects and Methods In total, 5953 patients with salivary cancer included in the National Cancer Database were identified. For each treatment interval, patients in the fourth quartile ("prolonged") were compared to patients in the first and second quartiles ("not prolonged"). Patient, tumor, and treatment characteristics were associated with prolonged times via multivariable binary logistic regression. Prolongation of each interval was associated with overall survival via multivariable Cox proportional hazards regression, controlling for clinically relevant factors. Results Median durations for diagnosis-to-treatment initiation, surgery-to-radiation treatment (RT), RT duration, total treatment package, and diagnosis-to-treatment end were 31, 44, 47, 92, and 110 days, respectively. Race, insurance status, comorbidities, age, T and N stage, facility volume and location, and a facility care transition from diagnosis to initial treatment were associated with prolonged treatment time. Prolonged RT duration was associated with decreased overall survival (OS) (62% vs 75% 5-year OS, HR = 1.26 [95% confidence interval (CI), 1.09-1.47]; P = .002), but prolonged diagnosis-to-treatment initiation, surgery-to-RT, total treatment package, and diagnosis-to-treatment end intervals were not (70% vs 67% 5-year OS, HR = 1.11 [95% CI, 0.92-1.34], P = .284; 72% vs 68%, HR = 0.93 [95% CI, 0.79-1.09], P = .370; 70% vs 70%, HR = 1.00 [95% CI, 0.84-1.20], P = .974; 66% vs 71%, HR = 0.99 [95% CI, 0.84-1.18], P = .920, respectively). Conclusion The median durations identified here can serve as reference points. Radiation therapy duration is associated with overall survival in salivary cancer and could be considered a quality indicator.

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Assessing delays in laryngeal cancer treatment

Abstract: 4. Laryngoscope, 126:1612-1615, 2016.

Cited by 27 publications

References 18 publications

Clinical Practice Guideline: Hoarseness (Dysphonia) (Update)

Clinical Practice Guideline: Hoarseness (Dysphonia) (Update)

Laryngeal Cancer Attributable Factors and the Influence on Survival Rates: A Single Brazilian Institution Experience

Treatment Times in Salivary Gland Cancer: National Patterns and Association with Survival

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