The impact of time to treatment initiation on survival from head and neck cancer in north-eastern Italy

Polesel, Jerry; Furlan, Carlo; Birri, Silvia; Giacomarra, Vittorio; Vaccher, Emanuela; Grando, Giuseppe; Gobitti, Carlo; Navarria, Federico; Schioppa, Ornella; Minatel, Emilio; Bidoli, Ettore; Barzan, Luigi; Franchin, Giovanni

doi:10.1016/j.oraloncology.2017.02.009

Cited by 56 publications

(57 citation statements)

References 14 publications

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“…10,19,22,30,34,36,39 The articles generally used cancer registry data as a data source (9 [69%]) 10,22,30–35,37,38 ; as a result, the sample sizes were large (>1500 patients). Six studies (46%) 10,33,36–39 included all head and neck subsites, while 7 studies (54%) were subsite specific (5 oral cavity, 1 oropharynx, and 1 larynx). 19,22,30–32,34,35 Four of the studies (31%) 22,31,33,36 did not define the rationale or methods for their definition of prolonged DTI, 4 (31%) 19,35,37,38 used calendar-based categorical definitions (eg, <30 days, 31–60 days), 3 (23%) 30,34,39 used cohort-based quartiles or medians, and 2 (15%) 10,32 used recursive partition analysis to determine an optimal DTI threshold.…”

Section: Resultsmentioning

confidence: 99%

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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

213

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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Section: Resultsmentioning

confidence: 99%

“…Despite heterogeneity in definitions of delayed DTI, most studies included in this review did find an association between prolonged DTI and decreased survival, 10,22,31,32 although 1 study found an association only at the extreme DTI interval with no association between DTI and survival for the intermediate categories. 33 …”

Section: Discussionmentioning

confidence: 99%

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

Graboyes

Kompelli

Neskey

et al. 2019

JAMA Otolaryngol Head Neck Surg

213

313

View full text Add to dashboard Cite

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“…Delays in treatment have been shown in multiple studies to correlate with worse outcomes in patients with head and neck cancer . As many studies of time to treatment initiation have been performed used large databases, patient‐specific details—including patterns‐of‐failure—were not available, and thus the mechanism explaining inferior overall survival have not been explained.…”

Section: Discussionmentioning

confidence: 99%

“…Delays in treatment have been shown in multiple studies to correlate with worse outcomes in patients with head and neck cancer. 2,9 As many studies of time to treatment initiation have been performed used large databases, patientspecific details-including patterns-of-failure-were not available, and thus the mechanism explaining inferior overall survival have not been explained. In our series, we have shown that pBTS time is associated with an increased risk of metastatic disease and thus may be the mechanism by which delays in treatment initiation lead to worse overall survival.…”

Section: Discussionmentioning

confidence: 99%

Association between treatment delays and oncologic outcome in patients treated with surgery and radiotherapy for head and neck cancer

et al. 2018

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Background This study sought to determine the oncologic impact of delays to surgery, radiotherapy, and completion of therapy in patients with head and neck squamous cell carcinoma. Methods The impact of biopsy to surgery (BTS) time, surgery to start of radiation time (STSR), and radiation treatment time (RTT) on locoregional recurrence (LRR), distant metastases (DMs), and cancer‐specific mortality (CSM) was examined. The cumulative incidences (CI) of LRR, DMs, and CSM were examined using Fine–Gray testing. Results A total of 277 patients treated with surgery and adjuvant radiotherapy were analyzed. On multivariable testing, BTS >50 days was associated with DM (P = .03), whereas RTT and STSR were not. RTT >43 days was associated with LRR (P = .02) in patients with non‐p16‐positive‐oropharynx cancer. Conclusions An increase in DM appears to be the mechanism by which prolonged time to treatment initiation leads to worse overall survival. Prolonged RTT has the greatest impact on patients with non‐p16 positive oropharynx cancers.

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“…Large series from the United States and Europe show that reducing pre-treatment wait time correlates with improved survival outcomes. 3,[5][6][7] Time to treatment initiation (TTI) is the most widely used measure of wait time. It is defined as the period between tissue diagnosis and treatment commencement.…”

Section: Introductionmentioning

confidence: 99%

Pre‐treatment wait time for head and neck cancer patients in Western Australia: description of a new metric and examination of predictive factors

Flukes

Garry

Hinton-Bayre

et al. 2018

ANZ Journal of Surgery

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Background Prolonged pre‐treatment wait times in head and neck cancer are associated with increased morbidity and reduced survival. Traditional metrics exclude delays prior to biopsy, which represents an important and measurable period of time. This study aims to describe total wait time for head and neck cancer patients in our institution, to define a more accurate representation of the clinically relevant pre‐treatment wait time, and to evaluate predictive factors for prolonged wait times. Methods A retrospective review of head and neck cancer patients treated over 2 years in a tertiary referral centre was conducted. Patient demographics, referral symptoms, tumour details, treatment plan and key dates were analysed to identify total wait time and factors predictive of increased wait time. Results Two hundred and ninety‐four patients were included. Mean total wait time from initial referral to treatment initiation was 71.6 (median 61) days. The period from referral to biopsy represented 29% of mean total wait time. Factors predictive of increased wait time included presenting symptom of hoarseness, laryngeal cancer and treatment with definitive radiotherapy. Conclusions This study demonstrates that time from referral to biopsy represents a significant portion of total wait time, and we suggest that this be incorporated into future wait time metrics for improved clinical relevance. Furthermore, we have identified factors predicting increased wait time which can be targeted for future service improvement.

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The impact of time to treatment initiation on survival from head and neck cancer in north-eastern Italy

Cited by 56 publications

References 14 publications

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

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

Association between treatment delays and oncologic outcome in patients treated with surgery and radiotherapy for head and neck cancer

Pre‐treatment wait time for head and neck cancer patients in Western Australia: description of a new metric and examination of predictive factors

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