National treatment times in oropharyngeal cancer treated with primary radiation or chemoradiation

Morse, Elliot; Judson, Benjamin L.; Husain, Zain; Burtness, Barbara; Yarbrough, Wendell G.; Sasaki, Clarence T.; Cheraghlou, Shayan; Mehra, Saral

doi:10.1016/j.oraloncology.2018.02.010

Cited by 17 publications

(64 citation statements)

References 56 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In patients with HPV‐negative tumors, a DTS ≥ 11 days (the optimal predictive threshold for patients with HPV‐negative tumors) led to a more than 1.5‐fold increase in the risk of mortality; however, rising DTS had no significant effect on survival in HPV‐positive tumors. In their analysis of the NCDB, Morse et al found that delays in the time from diagnosis to the initiation of adjuvant radiation (defined as highest quartile for treatment time) did not impact survival in patients with either HPV‐positive or ‐negative OSCC . By using RPA, we demonstrate that an earlier threshold than the highest quartile may better capture survival differences due to treatment delay in the HPV‐negative cohort.…”

Section: Discussionmentioning

confidence: 70%

“…In their analysis of the NCDB, Morse et al found that delays in the time from diagnosis to the initiation of adjuvant radiation (defined as highest quartile for treatment time) did not impact survival in patients with either HPV-positive or -negative OSCC. 29 By using RPA, we demonstrate that an earlier threshold than the highest quartile may better capture survival differences due to treatment delay in the HPV-negative cohort. It has been proposed that the mechanism for increased mortality with rising time to initiate treatment may be related to upstaging of disease in the diagnosis to treatment interval.…”

Section: Discussionmentioning

confidence: 85%

See 1 more Smart Citation

Survival impact of treatment delays in surgically managed oropharyngeal cancer and the role of human papillomavirus status

et al. 2019

View full text Add to dashboard Cite

Background The impact of treatment delays on survival in oropharyngeal cancer and whether the effect varies by human papillomavirus (HPV) status have yet to be defined. Methods Retrospective analysis of the survival impact of time from diagnosis to surgery (DTS), surgery to radiation (SRT), and duration of radiation (RTD) for patients in the National Cancer Database with resected oropharyngeal cancer who underwent adjuvant radiation from 2010 to 2014. Results We identified optimal thresholds of 30, 40, and 51 days for DTS, SRT, and RTD, respectively, with treatment times exceeding these thresholds associated with significantly worse overall survival. Prolonged SRT and RTD were associated with mortality regardless of HPV status, although rising DTS was only predictive among patients with HPV‐negative tumors. Conclusions Treatment delays significantly impact survival in oropharyngeal cancer. The consequences of prolonged DTS may be stronger in HPV‐negative than HPV‐positive disease. These data serve as a foundation for future research and clinical management.

show abstract

Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 85%

Survival impact of treatment delays in surgically managed oropharyngeal cancer and the role of human papillomavirus status

et al. 2019

View full text Add to dashboard Cite

show abstract

“…The majority of the cases that fall into this category are mucosal HNSCC. As previously mentioned, there is evidence to suggest that delayed time to treatment initiation in HNSCC patients may result in poorer oncologic outcomes 15‐22 . In our opinion, during triage levels 1 and 2 of the pandemic, it is reasonable to proceed with these oncologic cases to avoid delay in treatment.…”

Section: Criteria For Prioritizing Patients Requiring Head and Neck Smentioning

confidence: 78%

“…Head and neck squamous cell carcinoma (HNSCC) can progress and upstage during a prolonged time to treatment initiation (TTI) 15 . This may lead to an increase in mortality and likelihood of recurrence whether treated with a surgical or nonsurgical approach 15‐22 . In addition, delayed TTI can evoke patient anxiety as the patient may feel that not enough is being done to address their cancer 23 .…”

Section: Delay In Head and Neck Cancer Therapymentioning

confidence: 99%

Framework for prioritizing head and neck surgery during the COVID‐19 pandemic

et al. 2020

View full text Add to dashboard Cite

The COVID-19 pandemic has placed an extraordinary demand on the United States health care system. Many institutions have canceled elective and nonurgent procedures to conserve resources and limit exposure. While operational definitions of elective and urgent categories exist, there is a degree of surgeon judgment in designation. In the present commentary, we provide a framework for prioritizing head and neck surgery during the pandemic. Unique considerations for the head and neck patient are examined including risk to the oncology patient, outcomes following delay in head and neck cancer therapy, and risk of transmission during otolaryngologic surgery. Our case prioritization criteria consist of four categories: urgent-proceed with surgery, less urgentconsider postpone > 30 days, less urgent-consider postpone 30 to 90 days, and case-by-case basis. Finally, we discuss our preoperative clinical pathway for transmission mitigation including defining low-risk and high-risk surgery for transmission and role of preoperative COVID-19 testing.

show abstract

“…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.…”

Section: Discussionmentioning

confidence: 99%

Treatment delays in surgically managed sinonasal cancer and association with survival

et al. 2019

View full text Add to dashboard Cite

Objective: To characterize treatment delays in sinonasal cancer managed with surgery and adjuvant radiation and determine the associated impact on survival.Study Design: Retrospective cohort study. Methods: We identified adults in the National Cancer Database treated for sinonasal squamous cell carcinoma with definitive surgery followed by adjuvant radiation from 2004 to 2014. We then examined intervals of diagnosis to surgery (DTS), surgery to radiation (SRT), and radiation duration (RTD). Next, we performed recursive partitioning analysis (RPA) to identify thresholds for these treatment intervals that estimated the greatest differences in survival. We determined the association of treatment delay with overall survival using Cox proportional hazards regression.Results: Among 2,267 patients included, median durations of DTS, SRT, and RTD were 32, 49, and 47 days, respectively. Predictors of treatment delay included care transitions, black race, and Medicare insurance. We identified thresholds of 26, 64, and 51 days for DTS, SRT, and RTD, respectively, as estimating the largest survival differences. Delays in SRT (hazard ratio [HR] 1.20; 95% confidence interval [CI], 1.03-1.40), and RTD (HR, 1.27; 95% CI, 1.10-1.46) beyond these thresholds independently predicted mortality. Delay in DTS beyond the RPA-derived threshold was not significantly associated with mortality after adjusting for other covariates.Conclusion: Delays in SRT and RTD intervals are associated with decreased overall survival. Median durations may serve as national benchmarks. Treatment delays could be considered quality indicators for sinonasal cancer treated with surgery and adjuvant radiation.

show abstract

National treatment times in oropharyngeal cancer treated with primary radiation or chemoradiation

Cited by 17 publications

References 56 publications

Survival impact of treatment delays in surgically managed oropharyngeal cancer and the role of human papillomavirus status

Survival impact of treatment delays in surgically managed oropharyngeal cancer and the role of human papillomavirus status

Framework for prioritizing head and neck surgery during the COVID‐19 pandemic

Treatment delays in surgically managed sinonasal cancer and association with survival

Contact Info

Product

Resources

About