Survival impact of treatment delays in surgically managed oropharyngeal cancer and the role of human papillomavirus status

Goel, Alexander N.; Frangos, Mariana I.; Raghavan, Govind; Sangar, Sophia; Lazaro, Stephanie L de Sam; Wang, Marilene B.; Long, Jennifer L.; John, Maie A. St.

doi:10.1002/hed.25643

Cited by 17 publications

(29 citation statements)

References 40 publications

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“…The SRT threshold predicting the largest differences in survival was 64 days. This was considerably longer than the SRT thresholds identified in similar studies of laryngeal (47 days), oropharyngeal (41 days), and multisite head and neck (50 days) cohorts. Current National Comprehensive Cancer Network guidelines recommend initiating radiotherapy within 42 days of surgery .…”

Section: Discussionmentioning

confidence: 67%

“…Multivariable Cox proportional hazard regression was used to analyze the survival impact of prolonged treatment intervals, modeled as continuous variables. Optimal thresholds of DTS, SRT, and RTD that estimated the largest differences in OS were identified through recursive partitioning analysis (RPA) . Kaplan‐Meier models were then used to estimate survival based on these thresholds, with comparisons via log‐rank tests.…”

Section: Methodsmentioning

confidence: 99%

“…Kaplan‐Meier models were then used to estimate survival based on these thresholds, with comparisons via log‐rank tests. To confirm the predictive value of these cutoffs after controlling for other covariates, we performed multivariable Cox regression with DTS, SRT, and RTD modeled as continuous variables using restricted cubic splines with 4 knots with the RPA‐derived thresholds as the reference values …”

Section: Methodsmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 67%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Treatment delays in surgically managed sinonasal cancer and association with survival

et al. 2019

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“…Head and neck squamous cell carcinoma (HNSCC) can progress and upstage during a prolonged time to treatment initiation (TTI) 15 . This may lead to an increase in mortality and likelihood of recurrence whether treated with a surgical or nonsurgical approach 15‐22 . In addition, delayed TTI can evoke patient anxiety as the patient may feel that not enough is being done to address their cancer 23 .…”

Section: Delay In Head and Neck Cancer Therapymentioning

confidence: 99%

Framework for prioritizing head and neck surgery during the COVID‐19 pandemic

et al. 2020

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The COVID-19 pandemic has placed an extraordinary demand on the United States health care system. Many institutions have canceled elective and nonurgent procedures to conserve resources and limit exposure. While operational definitions of elective and urgent categories exist, there is a degree of surgeon judgment in designation. In the present commentary, we provide a framework for prioritizing head and neck surgery during the pandemic. Unique considerations for the head and neck patient are examined including risk to the oncology patient, outcomes following delay in head and neck cancer therapy, and risk of transmission during otolaryngologic surgery. Our case prioritization criteria consist of four categories: urgent-proceed with surgery, less urgentconsider postpone > 30 days, less urgent-consider postpone 30 to 90 days, and case-by-case basis. Finally, we discuss our preoperative clinical pathway for transmission mitigation including defining low-risk and high-risk surgery for transmission and role of preoperative COVID-19 testing.

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“…We used a scale ranging from 0 to 9 in rounds 1 and 2 to indicate the decision to not operate (0) or low priority (scores 1-3), intermediate priority (scores 4-6), or high priority (scores 7-9). For rounds 3 and 4, we used a scale from 1 to 9 to rate each indication compared with other indications within each of the priority groupings as either less important (1-3), neutral (4-6), or more important (7)(8)(9).…”

Section: Consensus Processmentioning

confidence: 99%

Development and validation of a Surgical Prioritization and Ranking Tool and Navigation Aid for Head and Neck Cancer (SPARTAN‐HN) in a scarce resource setting: Response to the COVID‐19 pandemic

Almeida

Noel

Forner

et al. 2020

Cancer

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BACKGROUND: In the wake of the coronavirus disease 2019 (COVID-19) pandemic, access to surgical care for patients with head and neck cancer (HNC) is limited and unpredictable. Determining which patients should be prioritized is inherently subjective and difficult to assess. The authors have proposed an algorithm to fairly and consistently triage patients and mitigate the risk of adverse outcomes. METHODS: Two separate expert panels, a consensus panel (11 participants) and a validation panel (15 participants), were constructed among international HNC surgeons. Using a modified Delphi process and RAND Corporation/University of California at Los Angeles methodology with 4 consensus rounds and 2 meetings, groupings of high-priority, intermediate-priority, and low-priority indications for surgery were established and subdivided. A point-based scoring algorithm was developed, the Surgical Prioritization and Ranking Tool and Navigation Aid for Head and Neck Cancer (SPARTAN-HN). Agreement was measured during consensus and for algorithm scoring using the Krippendorff alpha. Rankings from the algorithm were compared with expert rankings of 12 case vignettes using the Spearman rank correlation coefficient. RESULTS: A total of 62 indications for surgical priority were rated. Weights for each indication ranged from −4 to +4 (scale range; −17 to 20). The response rate for the validation exercise was 100%. The SPARTAN-HN demonstrated excellent agreement and correlation with expert rankings (Krippendorff alpha, .91 [95% CI, 0.88-0.93]; and rho, 0.81 [95% CI, 0.45-0.95]). CONCLUSIONS: The SPARTAN-HN surgical prioritization algorithm consistently stratifies patients requiring HNC surgical care in the COVID-19 era. Formal evaluation and implementation are required. Cancer 2020;126:4895-4904.

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Survival impact of treatment delays in surgically managed oropharyngeal cancer and the role of human papillomavirus status

Cited by 17 publications

References 40 publications

Treatment delays in surgically managed sinonasal cancer and association with survival

Treatment delays in surgically managed sinonasal cancer and association with survival

Framework for prioritizing head and neck surgery during the COVID‐19 pandemic

Development and validation of a Surgical Prioritization and Ranking Tool and Navigation Aid for Head and Neck Cancer (SPARTAN‐HN) in a scarce resource setting: Response to the COVID‐19 pandemic

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