Determinants of delay and association with outcome in head and neck cancer: A systematic review

Abstract

Introduction: Head and neck cancers (HNC) are relatively fast-growing tumours, and delay in treatment initiation is associated with tumour progression and adverse outcome. An overview of factors contributing to delay can provide critical insights on necessary adjustments to optimize care pathways. This systematic review aims to identify factors associated with delay and summarize the effect of delay on oncological outcome measures. Methods: A search strategy was conducted according to PRISMA guidelines to search electronic databases for studies assessing the carepathway interval (days between first visit in head and neck oncology center and treatment initiation) and/or time-to-treatment-initiation interval (days between histological diagnosis and treatment initiation) and 1) determinants of delay and/or 2) effect of delay on outcome within these timeframes. Due to heterogeneity between included studies, a meta-analysis was not possible. Results: Fifty-two studies were eligible for quantitative analysis. Non-Caucasian race, academic setting, Medicaid/no insurance and radiotherapy as primary treatment were associated with delay. Advanced tumour stage was related to increased time-to-treatment initiation in the four common sites combined (oral cavity, oropharynx, hypopharynx, larynx). Separate determinants for delay in different tumour locations were identified. In laryngeal, oral cavity cancer and the four common HNC sites combined, delay in start of treatment is associated with decreased overall survival, although no cut-off time point could be determined. Conclusion: Race, facility type, type of insurance and radiotherapy as primary treatment were associated with delay and subsequent inferior survival in the four common sites combined.

Factors associated with cancer treatment delay: a protocol for a systematic review and meta-analysis

“…9 Prepandemic factors found to be associated with delays in the initiation of cancer treatment include age, [10][11][12] race and ethnicity, 10 11 13 14 mental illness, 15 social determinants of health (eg, public vs private insurance, insurance coverage, geographic region in the USA), 10 13 14 16 clinical staging or size of tumour, 11 12 number of comorbidities, 11 16 treatment facility 11 and preoperative components (eg, imaging and biopsy type). 10 13 While a small number of reviews have evaluated factors associated with treatment delays, 17 no study, to the best of our knowledge, has robustly quantified the relative impact of these factors on treatment delays in a meta-analysis. Calculating point estimates for the odds of time-totreatment delay occurring within a specific time interval for patient, provider, disease and system-level factors has the potential to identify the most relevant factors contributing to treatment delay.…”

“…While a small number of reviews have evaluated factors associated with treatment delays, 17 no study, to the best of our knowledge, has robustly quantified the relative impact of these factors on treatment delays in a meta-analysis. Calculating point estimates for the odds of time-to-treatment delay occurring within a specific time interval for patient, provider, disease and system-level factors has the potential to identify the most relevant factors contributing to treatment delay.…”

The effect of treatment delay on quality of life and overall survival in head and neck cancer patients

“…The effect of prolonged time to treatment has recently been described in a recent systematic review (Schoonbeek, Zwertbroek, et al, 2021), reporting a strong association between delay and decreased overall survival. Although survival rates of HNSCC in general are increasing (Pulte & Brenner, 2010), the treatment of these complex tumours in vital areas can result in severe disabilities and permanent loss of function.…”

Experiences of Newly Diagnosed Oral Cancer Patients during the First Wave of the COVID-19 Pandemic: A Qualitative Study from Pakistan

“…Even under normal (non-pandemic) circumstances, oral cancer patients experience tremendous physical, psychological, and social impact from the disease and its treatment [ 11 ]. Delays in initiation and disruptions of treatment due to the COVID-19 pandemic may worsen not only the cancer prognosis but also the mental health of patients [ 12 , 13 ]. To the best of our knowledge, the experiences of newly diagnosed oral cancer patients during the COVID-19 pandemic has not been duly explored and reported.…”