Delays in Time to Head and Neck Cancer Treatment: A South Australian Perspective

Abstract

Background and Objectives: In head and neck cancer, delays in time to treatment are associated with poorer clinical outcomes. Within Australia, it is recommended that primary treatment is initiated within 56 days of initial referral. The aim of this study was to assess whether head and neck cancer treatment was delivered within these timeframe guidelines at our institution and identify factors associated with treatment delays. Methods: This retrospective cohort study assessed patients newly diagnosed with head and neck cancer over a 24 months period (2018 to 2019) at Flinders Medical Centre, Australia. Time to treatment intervals were calculated for comparison to local timeframe guidelines. Results: A total of 72 patients met the inclusion criteria. The median time from specialist referral to treatment initiation was 45.5 days (IQR 29–61), with 72% meeting the 56 days guideline. On univariate logistic regression, patients undergoing primary radiotherapy treatment were less likely to meet this guideline than those undergoing primary surgery (OR 8.8, 95% CI 2.6–28.9, p < 0.001), as were those requiring prophylactic gastrostomy tube insertion (OR 3.1, 95% CI 1.1–9.0, p < 0.05). Treatment initiation beyond 56 days had no significant impact on 12 months overall survival or disease-free survival. Conclusions: The findings of this study demonstrate that primary radiotherapy treatment is associated with delays in head and neck cancer treatment initiation, likely related to time consuming pre-treatment factors such as gastrostomy tube insertion.

Factors affecting timeliness in management of head and neck cancer

“…The duration between the definitive treatment decision and the commencement of treatment could also affect the timeliness of HNC management. Although our duration was consistent with previous Australian studies, 17,18 a recent Dutch study had reduced this period to 21 days. 33 Factors which may reduce delays in the commencement of treatment would include the frequency of HNC operating lists, dedicated HNC nurse coordinators, and the availability of all modalities of treatment within a health service, which are all limited by resources available to the health service.…”

“…Although previous studies had assessed the patient and physician factors associated with diagnostic delays, 12,15,16 including previous smaller Australian studies, 17,18 socioeconomic factors had not been analysed in Australian health systems. The primary objective of this study was to identify associations between patient factors including demographic and social factors, as well as referrer and treating team factors affecting timeliness in management.…”

Optimal cancer care pathways – the ideal versus reality for patient-centric cancer care during COVID-19

“…These results are the first known publication in Australia benchmarking performance against the nationally endorsed OCPs for multiple different tumour subsites. [13][14][15][16] These results demonstrate that there is overall poor compliance by all tumour subsites, with inconsistency in performance of individual components. Despite being a single institution study, the results and implications are likely to be applicable to most cancer services across Australia.…”

“…To reduce the impact of COVID-19 on diagnosis, pathways have also been adjusted in some countries, allowing primary care physicians increasing access to intervention and diagnostic investigations. 28 Despite this being the first published study that benchmarks performance against multiple different OCPs, [13][14][15][16] there are several limitations, which relate to the fundamental issues discussed above. Firstly, given the complex nature of the diagnostic pathway, mainly conducted in the private health sector with no data linkage between primary and specialist health care, this component of the OCP prior to MDM discussion was excluded from this study.…”

“…This is the only study in Australia that has assessed OCP compliance for multiple different tumour subsites, over a given period of time. [13][14][15][16]…”