Determinants of delay in the head and neck oncology care pathway: The next step in value‐based health care

Vries

Bras

et al. 2022

European J Cancer Care

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Objective: Head and neck squamous cell carcinomas (HNSCC) are rapidly developing tumours, and substantial delay in treatment initiation is associated with decreased overall survival. The effect of delay on health-related quality of life (HRQOL) is unknown. The aim of this study was to assess the impact of delay on QOL and overall survival.Methods: Patients with mucosal HNSCC were prospectively included. HRQOL and 2-year overall survival were analysed using linear mixed-model analyses and cox regression, respectively. Delay was defined as care pathway interval (CPI) of ≥30 days between first consultation and treatment initiation.Results: Median CPI was 39 days for the 173 patients included. A trend towards higher HRQOL-scores (indicating better HRQOL) during 2-year follow-up for patients with delay in treatment initiation was visible in the adjusted models (HRQOL summary score-β: 2.62, 95% CI: 0.57-4.67, p = 0.012). Factors associated with decreased overall survival were moderate comorbidities (HR: 5.10, 95% CI:1.65-15.76, p = 0.005) and stage-IV tumours (HR: 12.37, 95% CI: 2.81-54.39, p = 0.001). Delay was not associated with worse overall survival. Conclusion: Timely treatment initiation is challenging, especially for patients with advanced tumours and initial radiotherapy treatment. Encountering delay in treatment initiation did not result in clinically relevant differences in HRQOL-scores or decreased overall survival during 2-year follow-up. K E Y W O R D S head and neck neoplasms, overall survival, quality of life, time-to-treatment, treatment delay

Section: Discussionsupporting

confidence: 91%

Section: Methodsmentioning

confidence: 99%

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

Vries

Bras

et al. 2022

European J Cancer Care

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“…In this study, we did not find an association between delay and age. The proportion of patients treated within 30 days is comparable to other studies describing younger patients 21 or investigating delay in elderly patients (\70 vs 70 years). 24 This can be explained by the fact that due to the lifestyle of patients with HNC, a mismatch between chronological and biological age can often be experienced.…”

Section: Cpi and Determinants Of Delaysupporting

confidence: 80%

Impact of Delay on Hospitalization in Older Patients With Head and Neck Cancer: A Multicenter Study

Otolaryngol.--head neck surg.

Festen

Rashid

et al. 2022

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Objective To assess the impact of delay in treatment initiation on hospitalization, overall survival, and recurrence in older patients with head and neck cancer (HNC). Study Design Retrospective multicenter study. Setting Two tertiary referral centers. Methods All patients with newly diagnosed HNC (≥60 years) treated between 2015 and 2017 were retrospectively included. Time-to-treatment intervals were assessed (ie, calendar days between first visit and start of treatment). Multiple multivariable models were performed with hospital admission days (>14 days), survival, and recurrence as dependent outcome variables. Results In total, 525 patients were enrolled. The mean age was 70.7 years and 70.7% were male. Median time to treatment was 34.0 days, and 36.3% started treatment within 30 days ( P = .576 between centers). Patients with radiotherapy had longer time to treatment than surgical patients (39.0 vs 29.0 days, P < .001). Current smoking status, stage IV tumors, and definitive radiotherapy were significantly associated with delay in the multivariable analysis. Time-to-treatment interval ≥30 days was a significant predictor of longer hospital admission (>14 days) in the first year after treatment in an adjusted model (odds ratio, 4.66 [95% CI, 2.59-8.37]; P < .001). Delay in treatment initiation was not associated with overall survival or tumor recurrence. Conclusion This study highlights the importance and challenges of ensuring timely treatment initiation in older patients with HNC, as treatment delay was an independent predictor of hospitalization. During oncologic workup, taking time to consider patient-centered outcomes (including minimizing time spent in hospital) while ensuring timely start of treatment requires well-structured, fast-track care pathways.

“…the time-to-treatment interval (TTI), i.e. the number of days between histopathological biopsy and the start of treatment [24] . Patients whose dates were unknown and those who did not receive primary treatment were not included in CPI or TTI analyses.…”

Section: Methodsmentioning

confidence: 99%

“…the time-to-treatment interval (TTI), i.e. the number of days between histopathological biopsy and the start of treatment [24].…”

Section: Definitionsmentioning

confidence: 99%

Fewer head and neck cancer diagnoses and faster treatment initiation during COVID-19 in 2020: A nationwide population-based analysis

Radiotherapy and Oncology

Jel

Dijk

et al. 2022

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Background Inevitably, the emergence of COVID-19 has impacted non-COVID care. Because timely diagnosis and treatment are essential, especially for patients with head and neck cancer (HNC) with fast-growing tumours in a functionally and aesthetically important area, we wished to quantify the impact of the COVID-19 pandemic on HNC care in the Netherlands. Material and Methods This population-based study covered all, in total 8468, newly diagnosed primary HNC cases in the Netherlands in 2018, 2019 and 2020. We compared incidence, patient and tumour characteristics, primary treatment characteristics, and time-to-treatment in the first COVID-19 year 2020 with corresponding periods in 2018 and 2019 (i.e. pre-COVID). Results The incidence of HNC was nearly 25% less during the first wave (n=433) than in 2019 (n=595) and 2018 (n=598). In April and May 2020, the incidence of oral cavity and laryngeal carcinomas was significantly lower than in pre-COVID years. There were no shifts in tumour stage or alterations in initial treatment modalities. Regardless of the first treatment modality and specific period, the median number of days between first visit to a HNC centre and start of treatment was significantly shorter during the COVID-19 year (26 – 28 days) than pre-COVID (31 – 32 days, p<0.001). Conclusion The incidence of HNC during the Netherlands’ first COVID-19 wave was significantly lower than expected. The expected increase in incidence during the remainder of 2020 was not observed. Despite the overloaded healthcare system, the standard treatment for HNC patients could be delivered within a shorter time interval.