Association between the diagnosis-to-treatment interval and overall survival in Taiwanese patients with oral cavity squamous cell carcinoma

Liao, Chun Ta; Chen, Hsin Ni; Wen, Yue; Lee, Shu Ru; Ng, Shu Hang; Liu, Tsang Wu; Tsai, Sen Tien; Tsai, Ming Hsui; Jia, Lin; Lou, Pei‐Jen; Wang, Cheng-Ping; Chu, Pen–Yuan; Leu, Yi Shing; Tsai, Kuo-Yang; Terng, Shyuang‐Der; Chen, Tsung Ming; Wang, Cheng‐Hsu; Chien, Chih Yen; Chen, Wen Cheng; Lee, Li Yu; Lin, Chien Yu; Lin, Chih Hung; Fang, Tuan‐Jen; Huang, Shiang‐Fu; Kang, Chung Jan; Chang, Kai Ping; Yang, Lan-Yan; Yen, Tzu Chen

doi:10.1016/j.ejca.2016.11.010

Cited by 37 publications

(51 citation statements)

References 16 publications

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“…This left 34 studies with unique populations for inclusion ( fig 1 , table 1 , table 2 ). 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 These studies included 1 272 681 patients, with a sample size ranging from 174 to 420 792 (appendix 3). Twenty eight studies were population or registry based, and six were institutional reports.…”

Section: Resultsmentioning

confidence: 99%

Mortality due to cancer treatment delay: systematic review and meta-analysis

Hanna

King

Thibodeau

et al. 2020

BMJ

782

713

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Objective To quantify the association of cancer treatment delay and mortality for each four week increase in delay to inform cancer treatment pathways. Design Systematic review and meta-analysis. Data sources Published studies in Medline from 1 January 2000 to 10 April 2020. Eligibility criteria for selecting studies Curative, neoadjuvant, and adjuvant indications for surgery, systemic treatment, or radiotherapy for cancers of the bladder, breast, colon, rectum, lung, cervix, and head and neck were included. The main outcome measure was the hazard ratio for overall survival for each four week delay for each indication. Delay was measured from diagnosis to first treatment, or from the completion of one treatment to the start of the next. The primary analysis only included high validity studies controlling for major prognostic factors. Hazard ratios were assumed to be log linear in relation to overall survival and were converted to an effect for each four week delay. Pooled effects were estimated using DerSimonian and Laird random effect models. Results The review included 34 studies for 17 indications (n=1 272 681 patients). No high validity data were found for five of the radiotherapy indications or for cervical cancer surgery. The association between delay and increased mortality was significant (P<0.05) for 13 of 17 indications. Surgery findings were consistent, with a mortality risk for each four week delay of 1.06-1.08 (eg, colectomy 1.06, 95% confidence interval 1.01 to 1.12; breast surgery 1.08, 1.03 to 1.13). Estimates for systemic treatment varied (hazard ratio range 1.01-1.28). Radiotherapy estimates were for radical radiotherapy for head and neck cancer (hazard ratio 1.09, 95% confidence interval 1.05 to 1.14), adjuvant radiotherapy after breast conserving surgery (0.98, 0.88 to 1.09), and cervix cancer adjuvant radiotherapy (1.23, 1.00 to 1.50). A sensitivity analysis of studies that had been excluded because of lack of information on comorbidities or functional status did not change the findings. Conclusions Cancer treatment delay is a problem in health systems worldwide. The impact of delay on mortality can now be quantified for prioritisation and modelling. Even a four week delay of cancer treatment is associated with increased mortality across surgical, systemic treatment, and radiotherapy indications for seven cancers. Policies focused on minimising system level delays to cancer treatment initiation could improve population level survival outcomes.

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Section: Resultsmentioning

confidence: 99%

Mortality due to cancer treatment delay: systematic review and meta-analysis

Hanna

King

Thibodeau

et al. 2020

BMJ

782

713

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“…Six studies (46%) 10,33,36–39 included all head and neck subsites, while 7 studies (54%) were subsite specific (5 oral cavity, 1 oropharynx, and 1 larynx). 19,22,30–32,34,35 Four of the studies (31%) 22,31,33,36 did not define the rationale or methods for their definition of prolonged DTI, 4 (31%) 19,35,37,38 used calendar-based categorical definitions (eg, <30 days, 31–60 days), 3 (23%) 30,34,39 used cohort-based quartiles or medians, and 2 (15%) 10,32 used recursive partition analysis to determine an optimal DTI threshold. One study, which exclusively examined cancer of the oral cavity, suggested that DTI of less than 20 days was optimal.…”

Section: Resultsmentioning

confidence: 99%

“…One study, which exclusively examined cancer of the oral cavity, suggested that DTI of less than 20 days was optimal. 32 The other study, which included all subsites, proposed that optimal treatment should begin within 46 to 52 days of diagnosis. 10 An association between delays in DTI and poorer oncologic outcomes was observed in 9 studies (69%).…”

Section: Resultsmentioning

confidence: 99%

Association of Treatment Delays With Survival for Patients With Head and Neck Cancer

Graboyes

Kompelli

Neskey

et al. 2019

JAMA Otolaryngol Head Neck Surg

214

313

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IMPORTANCE Delays in the delivery of care for head and neck cancer (HNC) are a key driver of poor oncologic outcomes and thus represent an important therapeutic target. OBJECTIVE To synthesize information about the association between delays in the delivery of care for HNC and oncologic outcomes. EVIDENCE REVIEW A systematic review of the English-language literature in PubMed/MEDLINE and Scopus published between January 1, 2007, and February 28, 2018, was performed to identify articles addressing the association between treatment delays and oncologic outcomes for patients with HNC. Articles that were included (1) addressed cancer of the oral cavity, oropharynx, hypopharynx, or larynx; (2) discussed patients treated in 2004 or later; (3) analyzed time of diagnosis to treatment initiation (DTI), time from surgery to the initiation of postoperative radiotherapy, and/or treatment package time (TPT; the time from surgery through the completion of postoperative radiotherapy); (4) included a clear definition of treatment delay; and (5) analyzed the association between the treatment time interval and an oncologic outcome measure. Quality assessment was performed using the Institute of Health Economics Quality Appraisal Checklist for Case Series Studies. FINDINGS A total of 18 studies met inclusion criteria and formed the basis of the systematic review. Nine studies used the National Cancer Database and 6 studies were single-institution retrospective reviews. Of the 13 studies assessing DTI, 9 found an association between longer DTI and poorer overall survival; proposed DTI delay thresholds ranged from more than 20 days to 120 days or more. Four of the 5 studies assessing time from surgery to the initiation of postoperative radiotherapy (and all 4 studies assessing guideline-adherent time to postoperative radiotherapy) found an association between a timely progression from surgery to the initiation of postoperative radiotherapy and improved overall or recurrence-free survival. Of the 5 studies examining TPT, 4 found that prolonged TPT correlated with poorer overall survival; proposed thresholds for prolonged TPT ranged from 77 days or more to more than 100 days. CONCLUSIONS AND RELEVANCE Timely care regarding initiation of treatment, postoperative radiotherapy, and TPT is associated with survival for patients with HNC, although significant heterogeneity exists for defining delayed DTI and TPT. Further research is required to standardize optimal time goals, identify barriers to timely care for each interval, and design interventions to minimize delays.

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“…31 One analysis of patients with HNSCC who received treatment between 2003 and 2005 detected a relation with delayed DTI and decreased survival only beyond 60 days, 5 whereas another Taiwanese study indicated that a DTI beyond 20 days increased mortality risk. 6 However, these cohorts comprised a heterogeneous mix of patients who received nonsurgical and surgical treatments, with and without radiation, and without certainty of whether therapy was completed. In addition, no adjustment was made for other treatment intervals, which we demonstrate as pivotal (Fig.…”

Section: Discussionmentioning

confidence: 99%

Quantitative survival impact of composite treatment delays in head and neck cancer

Kim

Tighiouart

et al. 2018

Cancer

108

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Increasing delays in postoperative and radiation intervals are associated independently with an escalating risk of mortality that plateaus beyond certain thresholds. Delays in initiating therapy, conversely, are eclipsed in importance when appraised in conjunction with the entire treatment course. Such findings may redirect focus to streamlining those intervals that are most sensitive to delays when considering survival burden. Cancer 2018. © 2018 American Cancer Society.

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Association between the diagnosis-to-treatment interval and overall survival in Taiwanese patients with oral cavity squamous cell carcinoma

Cited by 37 publications

References 16 publications

Mortality due to cancer treatment delay: systematic review and meta-analysis

Mortality due to cancer treatment delay: systematic review and meta-analysis

Association of Treatment Delays With Survival for Patients With Head and Neck Cancer

Quantitative survival impact of composite treatment delays in head and neck cancer

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