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

Abstract

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.

Predictors of Health Care Utilization Following Major Head and Neck Oncologic Surgery in Older Patients

“…In addition to health complications, older patients are faced with burdensome costs of treatment and postoperative care, with the burden of illness for HNC reported as $79,165 over 5 years per patient. 10 The projected cost of care for HNC in 2020 was estimated at $5.46 billion. 11 Optimizing postoperative care is vital for older patients as they recover from major head and neck surgery to avoid complications, minimize hospital readmissions, and decrease health care expenditure.…”

“…Furthermore, timely treatment initiation of HNC in older patients is essential in preventing hospitalization in the first year after treatment. In addition to health complications, older patients are faced with burdensome costs of treatment and postoperative care, with the burden of illness for HNC reported as $79,165 over 5 years per patient 10 . The projected cost of care for HNC in 2020 was estimated at $5.46 billion 11 …”