Increasing time to treatment initiation for head and neck cancer: An analysis of the National Cancer Database

Murphy, Colin T.; Galloway, Thomas J.; Handorf, Elizabeth A.; Wang, Lora; Mehra, Ranee; Flieder, Douglas B.; Ridge, John A.

doi:10.1002/cncr.29191

Cited by 120 publications

(196 citation statements)

References 44 publications

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“…37 Care transitions to academic facilities are rising 1 and are accompanied by an inherent increase in TTI, introducing immediate conflict with the survival findings of this analysis. However, the data should not be misinterpreted to suggest that increased TTI to pursue a second opinion is detrimental—the improved survival at academic and comprehensive facilities suggests the opposite.…”

Section: Discussionmentioning

confidence: 75%

“…Academic facilities had significantly higher median TTI (28 days) compared with comprehensive community and community programs, (23 days and 22 days, respectively; P <.001) and the highest percentage of patients transitioning care, a factor independently associated with increasing TTI. 1 Additional elements that demonstrated significant variation included age, insurance status, race, Hispanic ethnicity, income, and education. TTI did not vary by comorbidity ( P = .131).…”

Section: Resultsmentioning

confidence: 99%

“…1 Advances in pretreatment evaluations, 3,15 therapy 16,17 and referral to high-volume centers 18-20 improve outcome but increase TTI. This analysis of greater than 50,000 patients, with comorbidity assessments, establishes a consistent relationship between prolonged TTI as an independent predictor of worse mortality that is most consistent beyond 60 days.…”

Section: Discussionmentioning

confidence: 99%

“…Trends suggest that in 2015 more patients will be treated at academic centers and their resultant TTI will be even higher. 1 In 2011, 40% of patients treated with CRT at academic centers had TTI of greater than 46 days. The current analysis suggests that increasing TTI beyond the threshold established in this monograph alters HNSCC survival and represents a public health issue.…”

Section: Discussionmentioning

confidence: 99%

“…1 Rising TTI reflects increased use of sophisticated diagnostic and therapeutic techniques, increasing transitions in care, and perhaps a provider shortage. 2-4 Because the Institute of Medicine cites timeliness of care as a quality indicator 5 to serve as a surrogate for the availability of resources and health system efficiency, 6 the clinical ramifications of increasing TTI warrant investigation.…”

Section: Introductionmentioning

confidence: 99%

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Survival Impact of Increasing Time to Treatment Initiation for Patients With Head and Neck Cancer in the United States

Murphy

Galloway

Handorf

et al. 2016

JCO

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350

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Purpose To estimate the overall survival (OS) impact from increasing time to treatment initiation (TTI) for patients with head and neck squamous cell carcinoma (HNSCC). Methods Using the National Cancer Data Base (NCDB), we examined patients who received curative therapy for the following sites: oral tongue, oropharynx, larynx, and hypopharynx. TTI was the number of days from diagnosis to initiation of curative treatment. The effect of TTI on OS was determined by using Cox regression models (MVA). Recursive partitioning analysis (RPA) identified TTI thresholds via conditional inference trees to estimate the greatest differences in OS on the basis of randomly selected training and validation sets, and repeated this 1,000 times to ensure robustness of TTI thresholds. Results A total of 51,655 patients were included. On MVA, TTI of 61 to 90 days versus less than 30 days (hazard ratio [HR], 1.13; 95% CI, 1.08 to 1.19) independently increased mortality risk. TTI of 67 days appeared as the optimal threshold on the training RPA, statistical significance was confirmed in the validation set (P ≤ .001), and the 67-day TTI was the optimal threshold in 54% of repeated simulations. Overall, 96% of simulations validated two optimal TTI thresholds, with ranges of 46 to 52 days and 62 to 67 days. The median OS for TTI of 46 to 52 days or fewer versus 53 to 67 days versus greater than 67 days was 71.9 months (95% CI, 70.3 to 73.5 months) versus 61 months (95% CI, 57 to 66.1 months) versus 46.6 months (95% CI, 42.8 to 50.7 months), respectively (P < .001). In the most recent year with available data (2011), 25% of patients had TTI of greater than 46 days. Conclusion TTI independently affects survival. One in four patients experienced treatment delay. TTI of greater than 46 to 52 days introduced an increased risk of death that was most consistently detrimental beyond 60 days. Prolonged TTI is currently affecting survival.

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Section: Discussionmentioning

confidence: 75%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Survival Impact of Increasing Time to Treatment Initiation for Patients With Head and Neck Cancer in the United States

Murphy

Galloway

Handorf

et al. 2016

JCO

Self Cite

350

445

View full text Add to dashboard Cite

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Assessment of Time-to-Treatment Initiation and Survival in a Cohort of Patients With Common Cancers

et al. 2020

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Key Points Question What is the association between delays in treatment initiation for common cancers, as are necessary in resource-limited settings and pandemic conditions, with mortality? Findings In this cohort study including 2 241 706 patients with breast, prostate, non-small cell lung, and colon cancer, generally higher all-cause mortality was associated with increasing time to treatment, although the degree varied by cancer type and stage. Patients with colon and lung cancer had the highest mortality associated with increased time to treatment. Meaning These findings emphasize the importance of timely cancer treatment, and, in contrast to current pandemic-related guidelines, support more prompt definitive treatment for intermediate-risk and high-risk prostate cancer.

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Association of Care Processes With Timely, Equitable Postoperative Radiotherapy in Patients With Surgically Treated Head and Neck Squamous Cell Carcinoma

Janz

Kim

Hill

et al. 2018

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Delays in initiation of postoperative radiotherapy (PORT) after surgery for head and neck squamous cell carcinoma (HNSCC) are common, predominantly affect racial minorities, and are associated with decreased survival. Details regarding the care processes that contribute to timely, equitable PORT remain unknown. OBJECTIVE To determine care processes associated with timely, equitable PORT. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included patients 18 years or older undergoing surgery for HNSCC at the Medical University of South Carolina (MUSC), Charleston, followed by PORT (at MUSC or elsewhere) with or without chemotherapy from January 1, 2014, through December 31, 2016. Data were analyzed from September 15, 2017, through June 28, 2018. MAIN OUTCOMES AND MEASURES The main outcome measure was the proportion of timely, guideline-adherent initiation of PORT (≤6 weeks postoperatively). Secondary outcome measures included care processes associated with timely PORT. The association between process variables with timely PORT was explored using multivariable logistic regression analysis. Effect modification of the association between receipt of care processes and timely PORT by race was explored using interaction effects. RESULTS A total of 197 patients were included in the analysis; they were predominantly white (157 [79.7%]) and male (136 [69.0%]) with a mean age of 59 years (range, 28-89 years). Overall, 89 patients (45.2%) experienced a delay initiating PORT. African American patients had a 13.5% absolute increase in the rate of delayed PORT relative to white patients (21 of 37 [56.8%] vs 68 of 157 [43.3%]). The adjusted multivariable regression showed that the following care processes were associated with timely PORT: preoperative radiotherapy consultation (odds ratio [OR], 8.94; 95% CI, 1.64-65.53), PORT at MUSC (OR, 6.21; 95% CI, 1.85-24.75), pathology report within 7 postoperative days (OR, 4.14; 95% CI, 1.21-15.86), time from surgery to PORT referral of no longer than 10 days (OR, 12.14; 95% CI, 3.14-63.00), time from PORT referral to consultation of no longer than 10 days (OR, 10.76; 95% CI, 3.01-49.70), and time from PORT consultation to its start of no longer than 21 days (OR, 4.80; 95% CI 1.41-18.44). Analysis of interactions revealed no statistically significant differences between African American and white patients in receipt of key processes associated with timely PORT. CONCLUSIONS AND RELEVANCE Specific care processes are associated with guideline-adherent initiation of PORT. Novel strategies appear to be needed to ensure that these processes are performed for all patients with HNSCC, thereby facilitating timely, equitable PORT.

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Increasing time to treatment initiation for head and neck cancer: An analysis of the National Cancer Database

Cited by 120 publications

References 44 publications

Survival Impact of Increasing Time to Treatment Initiation for Patients With Head and Neck Cancer in the United States

Survival Impact of Increasing Time to Treatment Initiation for Patients With Head and Neck Cancer in the United States

Assessment of Time-to-Treatment Initiation and Survival in a Cohort of Patients With Common Cancers

Association of Care Processes With Timely, Equitable Postoperative Radiotherapy in Patients With Surgically Treated Head and Neck Squamous Cell Carcinoma

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