Evaluation of Time to Surgery and Its Effect on Prognosis in Head and Neck Cancer

Tham, Tristan; Leung, Edric; Khaymovich, Julian; Mitha, S; Olson, Caitlin; Wotman, Michael; Teegala, Sireesha; Coury, Josephine R.; Costantino, Peter D.

doi:10.1159/000500207

“…An association between delay and decreased overall survival was demonstrated in laryngeal cancer, oral cavity cancer and in the combination of the four common sites, although there are also studies that did not find this relationship [18,24,32,50]. Particularly in OPC, the majority of the studies did not support this association.…”

Section: Effect Of Delaymentioning

confidence: 95%

“…Notably, this association was mostly seen in the group with the longest TTI, the shortest significant delay being 45 days and the longest 90 days (Table 3). On the other hand, three studies showed no association between waiting time and survival [18,24,50].…”

Section: Effect Of Delay E Overall Survivalmentioning

confidence: 97%

“…Academic facility was reported as a risk factor for prolonged TTI, as were transition of care [7,22,23,27], and insurance by Medicaid (in USA studies) [7,18,22,27]. Increasing comorbidity index (Charlson) was associated with increased risk of delay [19,29], although three other studies found no significant association between comorbidity and delay [22,24,27].…”

Section: All Four Common Sitesmentioning

confidence: 99%

See 1 more Smart Citation

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

Schoonbeek

¹

,

Zwertbroek

²

,

Plaat

³

et al. 2021

European Journal of Surgical Oncology

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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.

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“…We similarly did not identify an association with time to treatment and stage change. This is in contrast to a study of all head and neck malignancies that identified an association between time to treatment and upstaging, 25 although the extent of the impact on outcomes is inconsistent across different studies 26–28 …”

Section: Discussionmentioning

confidence: 61%

Clinical Versus Pathologic Laryngeal Cancer Staging and the Impact of Stage Change on Outcomes

Contrera

¹

,

Hair

²

,

Prendes

³

et al. 2020

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Objectives/Hypothesis Evaluate the impact and accuracy of clinical laryngeal cancer staging. Study Design Retrospective cohort study. Methods Two hundred sixty‐five consecutive patients with laryngeal squamous cell carcinoma who underwent total laryngectomy from 2001 to 2017 were studied. Clinical versus pathologic tumor (T) and nodal (N) categories were compared. Logistic regression and Cox proportional hazards analyzed the association of stage change with perioperative factors and outcomes. Results Forty‐seven patients (17.7%, accuracy = 0.969 ± 0.010 [standard error]) changed between T1‐2 and T3‐4. Sixty‐four patients (24.1%, accuracy = 0.866 ± 0.020) had inaccurate N category. Salvage patients were less likely to have stage change (downstage: odds ratio [OR] = 0.20, 95% confidence interval [CI]: 0.08‐0.50, P < .001; upstage: OR = 0.41, 95% CI: 0.23‐0.74, P = .003), but more likely to have inaccurate nodal category (39.8% vs. 11.7%, P < .001). Patients with stage change tended to have greater odds of positive/close margins (upstage: OR = 1.78, 95% CI: 0.91‐3.5, P = .092) and chemotherapy (downstage: OR = 2.21, 95% CI: 0.80‐6.14, P = .128; upstage: OR = 1.87, 95% CI: 0.85‐4.11, P = .119). Stage change was associated with recurrence (P = .047) with downstaged patients less likely to recur (hazard ratio = 0.26, 95% CI: 0.08‐0.82, P = .021). Stage change was not associated with positron emission tomography scan, subsite, time to surgery, or mortality. Conclusions A third of laryngeal cancer patients were downstaged or upstaged after laryngectomy with 18% and 24% of clinical T and N categories inaccurate, respectively. Stage change was less common for salvage patients and associated with risk of recurrence. Level of Evidence 3 Laryngoscope, 131:559–565, 2021

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“…Academic facility was reported as a risk factor for prolonged TTI, as were transition of care [7,22,23,27], and insurance by Medicaid (in USA studies) [7,18,22,27]. Increasing comorbidity index (Charlson) was associated with increased risk of delay [19,29], although three other studies found no significant association between comorbidity and delay [22,24,27].…”

Section: All Four Common Sitesmentioning

confidence: 99%

Pathological Evaluation Response in Treatment of Peritoneal Carcinomatosis with Pressurized Intraperitoneal Aerosol Chemotherapy – PIPAC. Palliative or Downstaging therapy?

Salem

¹

,

Coan

²

,

Lobo

³

et al. 2021

European Journal of Surgical Oncology

0

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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.

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Evaluation of Time to Surgery and Its Effect on Prognosis in Head and Neck Cancer

Cited by 7 publications

References 14 publications

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

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

Clinical Versus Pathologic Laryngeal Cancer Staging and the Impact of Stage Change on Outcomes

Pathological Evaluation Response in Treatment of Peritoneal Carcinomatosis with Pressurized Intraperitoneal Aerosol Chemotherapy – PIPAC. Palliative or Downstaging therapy?

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