Assessment of duration until initial treatment and its determining factors among newly diagnosed oral cancer patients

Abstract

Few studies have focused on the early treatment stages of cancer, and the impact of treatment delay on oncologic outcomes is poorly defined. We used oral cancer as an example to investigate the distribution of durations until initial treatment.This study was conducted using the National Health Insurance Research Database, which is linked to Taiwan's Cancer Registry and Death Registry databases. We defined “cutoff points for first-time treatment” according to a weekly schedule and sorted the patients into 2 groups based on whether their duration until initial treatment was longer or shorter than each cutoff. We then calculated the Kaplan–Meier estimator to determine the difference in survival rates between the 2 groups and performed logistic regression to identify determining factors.The average time between diagnosis and initial treatment was approximately 22.45 days. The average survival duration was 1363 days (standard deviation: 473.06 days). Oral cancer patients had no statistically significant differences in survival until a cutoff point of 3 weeks was used (with survival duration 71 days longer if initial treatment was received within 3 weeks). Patients with higher incomes or higher Charlson comorbidity index scores and patients treated at a hospital in a region with medium urbanization had lower likelihoods of treatment delay, whereas older patients were at higher risk of treatment delay.The attitudes, beliefs, and social contexts of oral cancer patients influence the treatment-seeking behaviors of these patients. Therefore, the government should advocate the merits of the referral system for cancer treatment or improve quality assurance for cancer diagnoses across different types of hospitals. Health authorities should also educate patients or use a case manager to encourage prompt treatment within 3 weeks and should provide screening and prevention services, particularly for high-risk groups, to reduce mortality risk.

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

“…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. One study, which exclusively examined cancer of the oral cavity, suggested that DTI of less than 20 days was optimal.…”

Impact of treatment delay on survival of oral/oropharyngeal cancers: Results of a nationwide screening program

“…The association between prolonged diagnosis-totreatment interval and unfavorable survival in head and neck squamous cell carcinoma (HNSCC) has been reported in several studies with the interval threshold ranging from 20 to 120 days. [14][15][16] Most of these studies used population-based database for analysis and found positive association between the decreased survival and the prolonged time interval from diagnosis to treatment initiation in the Netherlands, 17 northeastern Italy, 18 Denmark, 19 and the United States 20 with the corresponding hazard ratios of mortality 1.07, 1.13, 1.6, and 1.23, respectively. However, a recent large-scale study found that there was lack of such an association of treatment delay when focused only on cases of OSCC with OS in the United States, while the report from Taiwan 14 had a significant 12% increased risk of mortality.…”

“…16 18 20 22 24 26 28 30 38 28 26 21 22 17 11 13 10 11 8 9 12 9 8 6 5 6 4 4 2 4 5 7 5 4 2 3 7 4 1 1 2 2 3 1 3 1 2 1 32 34 36 38 40 42 44 46 49 52 No. of oral/oropharyngeal cancers Treatment delay (weeks) F I G U R E 1 Distribution of treatment delay in 5743 oral/oropharyngeal cancers T A B L E 1 Demographic characteristics and treatment delay of 5743 oral/oropharyngeal cancers Variable No…”

Association between hospital interval and survival in patients with oral cancer: A waiting time paradox

“…Two population-based cancer registry studies have shown poorer survival, with DTIs >20 and >30 days, respectively [26,27]. However, other studies with similar sample sizes have not been able to demonstrate this association for the same time interval [28–30], with DTIs ranging from 22 days [30] to 38 days [28]. The hospital interval also presented wide variability in the literature (15 days to 45 days) [16,17].…”