Compliance With Neoadjuvant Chemotherapy in T4 Oral Cancers: Place, Person, Socioeconomic Status, or Assistance

Abstract

PurposeApproximately 15% to 20% of our patients with head and neck cancer receiving neoadjuvant chemotherapy (NACT) discontinue therapy because of various nonmedical reasons. We sought to analyze the factors associated with treatment default and noncompliance among these patients.Patients and MethodsWe performed a retrospective analysis of patients with T4 oral cancer treated with NACT between January 2011 and December 2012. We included patients who discontinued treatment for nonmedical reasons before the second cycle of NACT. The factors analyzed were income, education, socioeconomic status, age, sex, place of residence, habits, and payment pattern (government supported or personal capacity). Pearson χ2 test was used to identify significant factors associated with noncompliance.ResultsOf 486 patients, 91 patients (18.7%) were noncompliant. Percentages of noncompliant patients in the age groups < 30, between 30 and 60, and > 60 years were 25.0%, 17.4%, and 25.5%, respectively (P = .27). Percentages of noncompliance in patients residing within the city, same state, or different state were 20.7%, 20.9%, and 17.1%, respectively (P = .44). Noncompliance rates were 20.3%, 15.7%, 18.1%, and 22.5% in upper middle, lower middle, upper lower, and lower economic strata, respectively (P = .60). Similarly, there was no significant difference in noncompliance according to occupation, education level, payment pattern, sex, or habits.ConclusionOur analysis failed to identify any specific significant factor associated with noncompliance with NACT among our patients with T4 oral cancers.

Neoadjuvant chemotherapy in geriatric head and neck cancers

“…The selection of the regimen was dependent on performance status, comorbidities, and socioeconomic status. This individualized treatment selection was associated with a high compliance rate of 93.9% and this is comparable or slightly better than the neoadjuvant chemotherapy compliance rate of 80% to 90% reported in younger patients from multiple studies in India . The incidence of 34.7% grades 3 to 4 events seen in this study seems high, but a majority were potentially “paper” toxicities as a result of frequent monitoring conducted in these patients during inpatient stays between days 4 to 10, as per protocol.…”

“…This is a heartening fact regarding the safety and tolerance of individualized neoadjuvant chemotherapy regimens in geriatric patients. Compliance to neoadjuvant chemotherapy is an issue in head and neck cancers; however, elderly age has not been consistently associated with an increased noncompliance rate …”

“…This individualized treatment selection was associated with a high compliance rate of 93.9% and this is comparable or slightly better than the neoadjuvant chemotherapy compliance rate of 80% to 90% reported in younger patients from multiple studies in India. 14,19,20 The incidence of 34.7% grades 3 to 4 events seen in this study seems high, but a majority were potentially "paper" toxicities as a result of frequent monitoring conducted in these patients during inpatient stays between days 4 to 10, as per protocol. This is a heartening fact regarding the safety and tolerance of individualized neoadjuvant chemotherapy regimens in geriatric patients.…”

“…Compliance to neoadjuvant chemotherapy is an issue in head and neck cancers; however, elderly age has not been consistently associated with an increased noncompliance rate. 19 The overall response rate was 41.3%. This response rate seems apparently lower than the response rate seen in the DeCIDE and Paradigm studies.…”