The association of treatment delay and prognosis in head and neck squamous cell carcinoma (HNSCC) patients in a Dutch comprehensive cancer center

Harten, Michel C. van; Ridder, Mischa de; Hamming‐Vrieze, Olga; Smeele, Ludi E.; Balm, Alfons J. M.; Brekel, Michiel W. M. van den

doi:10.1016/j.oraloncology.2013.12.018

Cited by 89 publications

(132 citation statements)

References 34 publications

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“…As opposed to the single center Dutch study that reported no relationship between longer waiting times and disease-specific and disease free survival in HNSCC patients [11], we hypothesized an impaired overall survival as a consequence of longer waiting times. Accordingly, our multivariable Cox regression model showed that longer waiting time, was significantly related to a higher hazard of dying.…”

Section: Discussionmentioning

confidence: 72%

“…However, a recent study including all types of treatment (N = 2493) in the Netherlands Cancer Institute revealed that there was no relation between waiting time for treatment up to 90 days and impaired survival. In one of the sub-analyses, a poorer survival was found for patients with shortest waiting time (<2 weeks) for treatment, and better survival for patients with moderate or longer waiting time [11]. This can be explained by the 'waiting time paradox', as a result of confounding by indication; patients with more advanced, rapidly progressive tumors and more severe symptoms are treated earlier, but have a higher mortality, leading to a U-shaped association between waiting time and survival [19,20].…”

Section: Introductionmentioning

confidence: 98%

“…Encouraged by governments and patient lobbies, fast-track programs are introduced throughout Europe to optimize care pathways and minimize the time for diagnosis, staging and treatment. There is evidence that these programs are reducing total waiting time, though these initiatives are not leading to waiting times that meet current standards set by professional societies and authorities [6][7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

“…In 2001, the DHNS anticipated to the growing number of patients per Center and to assure a high standard of care set the maximum duration between diagnosis and treatment at 30 days [22]. In a recent study, this target was only satisfied for 34% of the head and neck squamous cell carcinoma (HNSCC) patients between 1990 and 2011 [10,11].…”

Section: Introductionmentioning

confidence: 99%

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Determinants of treatment waiting times for head and neck cancer in the Netherlands and their relation to survival

et al. 2015

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Section: Discussionmentioning

confidence: 72%

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Determinants of treatment waiting times for head and neck cancer in the Netherlands and their relation to survival

et al. 2015

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“…Delays up to 90 days do not decrease overall survival rates but may produce the need for more aggressive surgical treatment and thus increase morbidity 5 . Delays can be caused by patient-related factors (time lapse from symptoms onset to first physician appointment) as well as healthcare provider-related causes (time lapse from first physician appointment to correct diagnosis, which may include referral delays to head and neck specialists, and the time lapse from diagnosis to treatment).…”

Section: Disease Stage At the Time Of First Physician Appointment Vs mentioning

confidence: 99%

Difficulties in the surgical management of head and neck cancer patient

Sarafoleanu

Vuzitas

Manea

2017

Romanian Journal of Rhinology

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Malignancies of the upper aerodigestive tract are high morbidity bearing and life-threatening diseases, which require thorough care from diagnostic suspicion and confirmation to surgical and/or oncologic treatment and rehabilitation. Difficulties in managing head and neck cancers arise from delays in diagnosis and treatment caused by either patient-related factors or healthcare system-related factors. Tumor origin and stage determine whether surgical excision is feasible, the approach required for safe excision, the extent of functional and aesthetic sacrifice required to attain oncologic safety and the need for reconstructive surgery. A thorough and systematic preoperative risk versus benefits assessment to select potential surgical candidates and give realistic outcomes is important from both a medical and a legal point of view. Because tumors in the head and neck region frequently involve more than one system and sensory organ, potential loss of function from either the disease course, surgical or nonsurgical treatment should be taken into account form a quality of life perspective. Effective management of head and neck cancer patients requires the cooperation and combined effort of a multidisciplinary team of surgeons, physicians and other workers over a long period of time which, in the absence of a specialised head and neck cancer centre and guidelines, can lead to increased morbidity and mortality, and patient dissatisfaction.

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Association of Treatment Delays With Survival for Patients With Head and Neck Cancer

Graboyes

Kompelli

Neskey

et al. 2019

JAMA Otolaryngol Head Neck Surg

214

313

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IMPORTANCE Delays in the delivery of care for head and neck cancer (HNC) are a key driver of poor oncologic outcomes and thus represent an important therapeutic target. OBJECTIVE To synthesize information about the association between delays in the delivery of care for HNC and oncologic outcomes. EVIDENCE REVIEW A systematic review of the English-language literature in PubMed/MEDLINE and Scopus published between January 1, 2007, and February 28, 2018, was performed to identify articles addressing the association between treatment delays and oncologic outcomes for patients with HNC. Articles that were included (1) addressed cancer of the oral cavity, oropharynx, hypopharynx, or larynx; (2) discussed patients treated in 2004 or later; (3) analyzed time of diagnosis to treatment initiation (DTI), time from surgery to the initiation of postoperative radiotherapy, and/or treatment package time (TPT; the time from surgery through the completion of postoperative radiotherapy); (4) included a clear definition of treatment delay; and (5) analyzed the association between the treatment time interval and an oncologic outcome measure. Quality assessment was performed using the Institute of Health Economics Quality Appraisal Checklist for Case Series Studies. FINDINGS A total of 18 studies met inclusion criteria and formed the basis of the systematic review. Nine studies used the National Cancer Database and 6 studies were single-institution retrospective reviews. Of the 13 studies assessing DTI, 9 found an association between longer DTI and poorer overall survival; proposed DTI delay thresholds ranged from more than 20 days to 120 days or more. Four of the 5 studies assessing time from surgery to the initiation of postoperative radiotherapy (and all 4 studies assessing guideline-adherent time to postoperative radiotherapy) found an association between a timely progression from surgery to the initiation of postoperative radiotherapy and improved overall or recurrence-free survival. Of the 5 studies examining TPT, 4 found that prolonged TPT correlated with poorer overall survival; proposed thresholds for prolonged TPT ranged from 77 days or more to more than 100 days. CONCLUSIONS AND RELEVANCE Timely care regarding initiation of treatment, postoperative radiotherapy, and TPT is associated with survival for patients with HNC, although significant heterogeneity exists for defining delayed DTI and TPT. Further research is required to standardize optimal time goals, identify barriers to timely care for each interval, and design interventions to minimize delays.

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The association of treatment delay and prognosis in head and neck squamous cell carcinoma (HNSCC) patients in a Dutch comprehensive cancer center

Cited by 89 publications

References 34 publications

Determinants of treatment waiting times for head and neck cancer in the Netherlands and their relation to survival

Determinants of treatment waiting times for head and neck cancer in the Netherlands and their relation to survival

Difficulties in the surgical management of head and neck cancer patient

Association of Treatment Delays With Survival for Patients With Head and Neck Cancer

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