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

Ho, Allen S.; Kim, Sungjin; Tighiouart, Mourad; Mita, Alain C.; Scher, Kevin S.; Epstein, Joel B.; Laury, Anna; Prasad, Ravi; Ali, Nabilah; Patio, Chrysanta; Clair, Jon Mallen–St.; Zumsteg, Zachary S.

doi:10.1002/cncr.31533

Cited by 76 publications

(117 citation statements)

References 33 publications

(49 reference statements)

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“…Treatment delay is associated with decreased disease control and survival, potentially driven by cancer stage progression or tumor cell repopulation after surgery prolonged treatment times . Although recent studies have analyzed treatment intervals for several different head and neck subsites, the impact of treatment delays in sinonasal cancer has yet to be elucidated.…”

Section: Introductionmentioning

confidence: 99%

Treatment delays in surgically managed sinonasal cancer and association with survival

et al. 2019

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Objective: To characterize treatment delays in sinonasal cancer managed with surgery and adjuvant radiation and determine the associated impact on survival.Study Design: Retrospective cohort study. Methods: We identified adults in the National Cancer Database treated for sinonasal squamous cell carcinoma with definitive surgery followed by adjuvant radiation from 2004 to 2014. We then examined intervals of diagnosis to surgery (DTS), surgery to radiation (SRT), and radiation duration (RTD). Next, we performed recursive partitioning analysis (RPA) to identify thresholds for these treatment intervals that estimated the greatest differences in survival. We determined the association of treatment delay with overall survival using Cox proportional hazards regression.Results: Among 2,267 patients included, median durations of DTS, SRT, and RTD were 32, 49, and 47 days, respectively. Predictors of treatment delay included care transitions, black race, and Medicare insurance. We identified thresholds of 26, 64, and 51 days for DTS, SRT, and RTD, respectively, as estimating the largest survival differences. Delays in SRT (hazard ratio [HR] 1.20; 95% confidence interval [CI], 1.03-1.40), and RTD (HR, 1.27; 95% CI, 1.10-1.46) beyond these thresholds independently predicted mortality. Delay in DTS beyond the RPA-derived threshold was not significantly associated with mortality after adjusting for other covariates.Conclusion: Delays in SRT and RTD intervals are associated with decreased overall survival. Median durations may serve as national benchmarks. Treatment delays could be considered quality indicators for sinonasal cancer treated with surgery and adjuvant radiation.

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Section: Introductionmentioning

confidence: 99%

Treatment delays in surgically managed sinonasal cancer and association with survival

et al. 2019

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“…Evidence points to expeditious treatment of HNSCC being critical to oncologic outcomes. 8 There are data showing uninsured patients having poorer oncologic outcomes compared to privately insured patients, though our study examines disparities within insured patients. 9 In our cohort, 78% of HMO patients did not meet the National Comprehensive Cancer Network (NCCN) recommendation of at most 6 weeks after surgery to start radiation.…”

Section: Discussionmentioning

confidence: 99%

Association of insurance type with time course of care in head and neck cancer management

et al. 2019

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Objectives/Hypothesis: To determine differences in time course of care based on major insurance types for patients with head and neck squamous cell carcinoma (HNSCC). Study Design: Retrospective cohort study. Methods: Retrospective study of Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and Medicare patients with biopsy-proven diagnosis of HNSCC referred to an academic tertiary center for tumor resection and adjuvant therapy. In addition to patient demographic information and tumor characteristics, duration of chief complaint and the following time points were collected: biopsy by referring physician, first specialty surgeon clinic appointment, surgery, and adjuvant radiation start and stop dates. Results: There was a statistically significant increase in time interval for HMO (n = 32) patients from chief complaint to biopsy (P = .003), biopsy to first specialty surgeon clinic appointment (P < .001), and surgery to start of adjuvant radiation (P < .001) compared to that of Medicare (n = 31) and PPO (n = 41) patients. Adjuvant radiation was initiated ≤6 weeks after surgery in 22% of HMO (mean duration of 59 AE 17 days), 48% of Medicare (44 AE 13 days), and 61% of PPO (41 AE 12 days) patients. Conclusions: Compared to PPO and Medicare patients, HMO patients begin adjuvant radiation after surgery later and experience treatment delays in transitions of care between provider types and with referrals to specialists. Delaying radiation after 6 weeks of surgery is a known prognostic factor, with insurance type playing a possible role. Further investigation is required to identify insurance type as an independent risk factor of delayed access to care for HNSCC.

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“…In radiation therapy, timeliness affects the efficacy of radiation therapy outcomes, 1,5,6 which, in turn, affects patient survival in many treatment sites. 2,7,8 The importance of timeliness in radiation therapy workflow must still be evaluated in the context of timeliness of the overall cancer care process, from diagnosis through every aspect of treatment. 9,10 We describe a departmental effort, conducted in phases, to systematically reduce the time interval from patient simulation to treatment initiation at our institution.…”

Section: Introductionmentioning

confidence: 99%

The Timeliness Initiative: Continuous Process Improvement for Prompt Initiation of Radiation Therapy Treatment

Agazaryan¹,

Chow²,

Lamb³

et al. 2020

Advances in Radiation Oncology

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The ambulatory patient experience is heavily influenced by wait times for provider care. Delayed patient visit start times may negatively affect overall satisfaction, and increased wait times affect the perception of the information, instructions, and treatment given by health care providers. Improving institutional practices overall requires the determination of the essential quality metrics that will make such an achievement possible. A protracted time leading up to the initiation of radiation therapy may promote poor satisfaction and perceived quality of care for both patients and referring providers alike, which may then create a barrier to patients being treated with radiation therapy. This institution piloted and sucessfully completed a study into improving the timeliness of initiation of patient radiation therapy for our patients. Methods and Materials: This work sought to identify inefficiencies in radiation therapy treatment planning to shorten the time each patient waited for treatment. We examined the time between simulation to the start of the first fraction of treatment. This period includes simulation, contouring, treatment planning, and quality assurance of the plan. Results: Before the study, the planning process would typically take 2 weeks. Target and organs-at-risk contouring were found to be the main inefficiency delaying treatment start dates. This delineating process includes drawing contours on radiologic images, typically computed tomography and magnetic resonance imaging. We focused on the time needed for the contouring process to be completed and took steps to increase efficiency. The length of time from simulation to contour approval was decreased by more than 60%, a reduction from an average of more than 4 days to less than 1.5 days. Overall planning time dropped from 2 weeks to less than 5 days. Conclusions: Process improvements and implementation of task-specific tools improved the timeliness of patient treatments, reducing the overall planning time from simulation to treatments to less than 5 days. Continuous monitoring and modification of these processes revealed that the successes achieved toward better quality of care have been sustained.

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

Cited by 76 publications

References 33 publications

Treatment delays in surgically managed sinonasal cancer and association with survival

Treatment delays in surgically managed sinonasal cancer and association with survival

Association of insurance type with time course of care in head and neck cancer management

The Timeliness Initiative: Continuous Process Improvement for Prompt Initiation of Radiation Therapy Treatment

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