Diagnosis to Treatment Interval and Outcome in Patients with Locally-Advanced Squamous Cell Carcinoma of the Head and Neck in a Veterans Affairs Medical Center

Brinkerhoff, Brian; Choong, Nicholas W.; Massey, Becky; Gore, Elizabeth; Firat, Selim; Wong, Stuart J.; Campbell, Bruce H.; Schapira, Ralph M.; Visotcky, Alexis; Tripp, Patrick

doi:10.4172/1948-5956.1000122

Cited by 3 publications

(9 citation statements)

References 11 publications

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“…Another 7 studies, found in the references of these 44 studies, were included, resulting in a total of 51 studies in this systematic review. 15-65…”

Section: Resultsmentioning

confidence: 99%

“…The effect of delay on recurrence was less extensively studied with occasionally conflicting results. However, the effects of time delays on survival were often studied, with increased delay associated with decreased overall survival in 8 21,27,45,48,[57][58][59]62 of the 14 studies yy investigating at least 1 type of time interval. Similar outcomes were found for disease-specific survival.…”

Section: Discussionmentioning

confidence: 99%

“…Twelve studies || examined the influence of delay on HNC tumor recurrence, 6 of which observed no correlations between different types of delay and local 20,22,40 or locoregional 21,24,42 recurrence. Fortin et al 27 found that a DTI greater than 40 days increases the risk of local recurrence by 2.6-fold, compared with DTI of 30 days or less.…”

Section: Local and Locoregional Recurrencementioning

confidence: 99%

“…62 In addition to these findings, the outcomes of 3 other studies showed a significant positive relationship between longer DTI and worse overall survival. 21,27,45 The most recent and extensive study by Murphy et al 45 included 51,655 patients with HNSCC who were treated with curative intent. The authors found that overall survival was significantly lower after a DTI of 61 days or more compared with an interval of 30 days or fewer.…”

Section: Survivalmentioning

confidence: 99%

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Impact of Time to Diagnosis and Treatment in Head and Neck Cancer: A Systematic Review

Schutte

Heutink

Wellenstein

et al. 2020

Otolaryngol.--head neck surg.

109

118

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Objective An increased interval between symptomatic disease and treatment may negatively influence oncologic and/or functional outcomes in head and neck cancer (HNC). This systematic review aims to provide insight into the effects of time to treatment intervals on oncologic and functional outcomes in oral cavity, pharyngeal, and laryngeal cancer. Data Sources PubMed, EMBASE, and Cochrane library were searched. Review Methods All studies on delay or time to diagnosis or treatment in oral, pharyngeal, and laryngeal cancer were included. Quality assessment was performed with an adjusted version of the Newcastle-Ottawa scale. Outcomes of interest were tumor volume, stage, recurrence, survival, patient-reported outcome measures (PROMs), toxicity, and functionality after treatment. Results A total of 51 studies were included. Current literature on the influence of delay in HNC is inconsistent but indicates higher stage and worse survival with longer delay. The effects on PROMs, toxicity, and functional outcome after treatment have not been investigated. The inconsistencies in outcomes were most likely caused by factors such as heterogeneity in study design, differences in the definitions of delay, bias of results, and incomplete adjustment for confounding factors in the included studies. Conclusion Irrespective of the level of evidence, the unfavorable effects of delay on oncologic, functional, and psychosocial outcomes are undisputed. Timely treatment while maintaining high-quality diagnostic procedures and decision making reflects good clinical practice in our opinion. This review will pose practical and logistic challenges that will have to be overcome.

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“…Another 7 studies, found in the references of these 44 studies, were included, resulting in a total of 51 studies in this systematic review. 15-65…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Local and Locoregional Recurrencementioning

confidence: 99%

Section: Survivalmentioning

confidence: 99%

See 2 more Smart Citations

Impact of Time to Diagnosis and Treatment in Head and Neck Cancer: A Systematic Review

Schutte

Heutink

Wellenstein

et al. 2020

Otolaryngol.--head neck surg.

109

118

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show abstract

“…1,4,5 Time-to-treatment intervals are particularly important for patients with HNC because, as mentioned before, these tumors are relatively fast growing in an anatomically and functionally complex and delicate area. Although the effect of time-to-treatment intervals on overall survival has been variably reported, [6][7][8][9] recent large studies have demonstrated the unfavorable effects of long timeto-treatment intervals. 2,10 These 2 studies of large cohorts of patients with HNC found that overall survival was significantly lower with larger intervals between diagnosis and treatment.…”

Section: Introductionmentioning

confidence: 99%

Impact of optimizing diagnostic workup and reducing the time to treatment in head and neck cancer

Schutte¹,

Broek²,

Steens³

et al. 2020

Cancer

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BACKGROUND: Timely and efficient diagnostic workup of patients with head and neck cancer (HNC) is challenging. This observational study describes the implementation of an optimized multidisciplinary oncological diagnostic workup for patients with HNC and its impact on diagnostic and treatment intervals, survival, costs, and patient satisfaction. METHODS: All patients with newly diagnosed HNC who underwent staging and treatment at the Radboud University Medical Center were included. Conventional workup (CW) in 2009 was compared with the fast-track, multidisciplinary, integrated care program, that is, optimized workup (OW), as implemented in 2014. RESULTS: The study included 486 patients with HNC (218 with CW and 268 with OW). The time-to-treatment interval was significantly lower in the OW cohort than the CW cohort (21 vs 34 days; P < .0001). The 3-year overall survival rate was 12% higher after OW (72% in the CW cohort vs 84% in the OW cohort; P = .002). After correction for confounders, the 3-year risk of death remained significantly lower in the OW cohort (hazard ratio, 1.73; 95% confidence interval, 1.14-2.63; P = .010). Total diagnostic costs were comparable in the 2 cohorts. The general satisfaction score, as measured with the Consumer Quality Index for Oncological Care, was significantly better in a matched OW group than the CW group (9.1 vs 8.5; P = .007). CONCLUSIONS: After the implementation of a fast-track, multidisciplinary, integrated care program, the time-to-treatment interval was significantly reduced. Overall survival and patient satisfaction increased significantly, whereas costs did not change. This demonstrates the impact and improved quality of care achieved by efficiently organizing the diagnostic phase of HNC management. Cancer 2020;126:3982-3990.

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Factors Associated With a Prolonged Diagnosis‐to‐Treatment Interval in Laryngeal Squamous Cell Carcinoma

Shaikh

Morrow

Stokes

et al. 2022

Otolaryngol.--head neck surg.

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Objective Evaluate factors associated with treatment delays and their effect on survival in laryngeal squamous cell carcinoma. Study Design Retrospective cohort study. Setting National Cancer Database. Methods Patients receiving primary radiation or surgery for laryngeal squamous cell carcinoma were included from 2004 to 2017. The primary outcomes were the diagnosis-to-treatment interval (DTI) and 5-year survival. Variables of prolonged DTI (>30 days) were assessed via logistic regression models. Survival was then assessed through Cox proportional hazards models. Candidate variables for both outcomes included age, sex, race, ethnicity, distance to treatment facility, insurance coverage, treatment facility type, TNM T stage, nodal status, and DTI (in models estimating survival). Results An overall 136,203 patients with laryngeal cancer were identified, from which 51,747 remained after exclusions were applied: 18,499 received primary surgery and 33,248 received primary radiation. Being a member of a racial or ethnic minority, advanced age, female sex, ≥30 miles from treatment facility, lack of insurance, treatment at an academic cancer center, and primary radiation were associated with a prolonged DTI. However, in spite of a faster DTI, treatment at a community cancer center was independently associated with higher mortality (hazard ratio, 1.2; P < .0001). Conclusions Despite being associated with prolonged DTI, receiving treatment at a high-volume academic facility was associated with significantly improved survival. Our results indicate that improved referral pathways or outreach may help improve survival in laryngeal cancer, especially in high-risk populations.

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Diagnosis to Treatment Interval and Outcome in Patients with Locally-Advanced Squamous Cell Carcinoma of the Head and Neck in a Veterans Affairs Medical Center

Cited by 3 publications

References 11 publications

Impact of Time to Diagnosis and Treatment in Head and Neck Cancer: A Systematic Review

Impact of Time to Diagnosis and Treatment in Head and Neck Cancer: A Systematic Review

Impact of optimizing diagnostic workup and reducing the time to treatment in head and neck cancer

Factors Associated With a Prolonged Diagnosis‐to‐Treatment Interval in Laryngeal Squamous Cell Carcinoma

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