Hypopharyngeal Cancer Treatment Delays: Benchmarks and Survival Association

Abstract

Objective To characterize treatment delays in hypopharyngeal cancer, identify factors associated with delays, and associate delays with overall survival. Study Design Retrospective cohort. Setting Commission on Cancer hospitals nationwide. Subjects and Methods We included patients in the National Cancer Database who were treated for hypopharyngeal cancer with primary radiation, concurrent chemoradiation, or induction chemotherapy and radiation. We identified median durations of diagnosis to treatment initiation (DTI), radiation treatment duration (RTD), and diagnosis to treatment end (DTE). We associated delays with patient, tumor, and treatment factors and overall survival via multivariable logistic and Cox proportional hazards regression, respectively. Results A total of 3850 patients treated with primary radiation or concurrent chemoradiation were included. Median durations of DTI, RTD, and DTE were 37, 52, and 92 days, respectively. Nonwhite race was associated with delays in DTI (odds ratio [OR] = 0.64; 95% CI, 0.51-0.80; P < .001) and DTE (OR = 0.60; 95% CI, 0.49-0.75; P < .001). Medicaid insurance was associated with delays in DTI (OR = 1.43; 95% CI, 1.07-1.90; P = .015), RTD (OR = 1.39; 95% CI, 1.06-1.83; P = .018), and DTE (OR = 1.48; 95% CI, 1.12-1.97; P = .007). Delays in RTD (hazard ratio [HR] = 1.24; 95% CI, 1.11-1.37; P < .001), not DTI (HR = 0.92; 95% CI, 0.82-1.03; P = .150) or DTE (HR = 1.01; 95% CI, 0.90-1.15; P = .825), were associated with impaired overall survival. We identified 922 patients who received induction chemotherapy. Delays in DTI, RTD, and DTE were not associated with overall survival in this cohort (HR = 1.10; 95% CI, 0.87-1.39; P = 0.435; HR = 1.05; 95% CI, 0.83-1.32; P = 0.686; HR = 1.11; 95% CI, 0.88-1.41; P = 0.377, respectively). Conclusions The median durations identified can serve as national benchmarks. Delays during radiation are associated with impaired overall survival among patients treated with primary radiation or chemoradiation but not patients treated with induction chemotherapy.

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

“…However, other studies by Morse et al 27‐29,34,35 to characterize treatment delays with OS on HNSCC using also NCDB from year 2004 to 2013 yielded variable results. According to these cohorts, the diagnosis to treatment initiation was not associated with poorer OS in oral cavity SCC, 37 primarily resected oropharyngeal SCC, 29 salivary gland cancer, 35 and hypopharyngeal cancer treated with induction chemotherapy 27 . Instead, treatment delays were associated with poorer survival only in hypopharyngeal cancer treated with primary radiation or chemoradiation 27 .…”

Treatment delays in surgically managed sinonasal cancer and association with survival

“…Compared to white patients, black patients experienced less timely care across all three treatment intervals that we studied. Multiple prior analyses have found black race to be associated with head and neck cancer treatment delays, as well as inferior local control and overall survival . A tendency to receive less timely care may underlie some of the disparities in oncologic outcomes for this population.…”

“…Of the multiple factors that may underlie prolonged DTS, care transitions appear to play a major role in sinonasal cancer. Patients in our study more commonly received treatment at a site other than the diagnosing facility (61%) compared to studies of salivary (33%), laryngeal (39%), or hypopharyngeal (43%) cancer using the same database. Such care transitions were among the strongest predictors of prolonged DTS.…”

Prognostic Case Volume Thresholds in Patients With Head and Neck Squamous Cell Carcinoma

“…Multiple studies [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] have reported the prognostic association of facility case volume on HNSCC outcomes and guideline adherence. To our knowledge, this is the first study to determine facility case volume thresholds for all HNSCCs.…”

“…The National Comprehensive Cancer Network guidelines specify that "outcomes are improved when patients with head and neck cancers are treated in highvolume centers." 2 and a rapidly expanding body of literature [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] supports this statement.…”