Premature discontinuation of curative radiation therapy: Insights from head and neck irradiation

Abstract

PurposeFactors related to premature discontinuation of curative radiation therapy (PDCRT) are understudied. This study aimed to examine causes and clinical outcomes of PDCRT at our institution by investigating the most common anatomical site associated with PDCRT.Methods and materialsAmong the 161 patients with PDCRT of various anatomic sites at our institution between 2010 and 2017, 36% received radiation to the head and neck region. Pertinent demographic, clinical, and treatment-related data on these 58 patients were collected. Survival was examined using the life-table method and log-rank test.ResultsThe majority of patients were male (81%), white (67%), ≥60 years old (59%), living ≥10 miles away from the hospital (60%), single (57%), with Eastern Cooperative Oncology Group score ≥1 (86%), experiencing significant pain issues (67%), and had treatment interruptions in radiation therapy (RT; 66%). The most common reasons for PDCRT were discontinuation against medical advice (33%), medical comorbidity (24%), and RT toxicity (17%). Of the comorbidities leading to PDCRT, 50% was acute cardiopulmonary issues and 43% was infection. The mean follow-up time was 15.9 months, and the 2-year overall survival and disease-specific survival rates were 61% and 78%, respectively. Patients with illicit substance abuse, cardiovascular disease, and Eastern Cooperative Oncology Group score ≥2 had worse survival. A trend toward improved survival with total completed dose ≥50 Gy versus <50 Gy existed (74% versus 44%, respectively; P = .07).ConclusionsIn this largest-to-date, modern analysis of PDCRT, the most common cause of discontinuation was discontinuation against medical advice, which underscores the importance of patient education, optimization of RT symptoms, involvement of social work, and integration of other supportive services early in treatment. Survival remains suboptimal after PDCRT for H&N tumors, with a 2-year overall survival rate of 61%. Completing >50 Gy appears to confer a relative therapeutic benefit.

Management of Older Adults with Locally Advanced Head and Neck Cancer

“…Additionally, older adult patients have been found to be at an increased risk of treatment interruption, which may be due to the treatment type as a more demanding treatment can contribute to an interruption [ 9 , 51 , 52 ]. Treatment interruptions are a concern in HNSCC patients as treatment interruptions are associated with worse tumor control [ 53 , 54 , 55 , 56 , 57 ]. In the older adult, treatment interruptions have also been associated with decreased OS [ 47 ] but not disease-related outcomes.…”

The Impact of Dental Care in Head and Neck Cancer Outcomes: A Systematic Review and Meta‐Analysis

“…21 Thus, improved rates of therapy completion in patients receiving dental care may play a role in the survival benefit, as supported by a recent study by Lazarev et al showing suboptimal survival in those with premature discontinuation of radiotherapy. 25 Farquhar et al described two possible explanations for their findings. The first possibility described is that oral health is a marker of overall health.…”

Discontinuation of palliative brain radiotherapy in patients with brain metastases

“…Searching PubMed for reports on radiotherapy discontinuation (query syntax: “((discontinuation[Title]) OR (stop[Title]) OR (termination[Title]) OR (abort[Title])) AND ((radiotherapy[Title]) OR (radiation[Title]))”) yielded 44 results, four of which were original articles discussing the permanent discontinuation of radiotherapy [7–10]. Lebwohl and colleagues analyzed treatment discontinuation during radiochemotherapy for rectal cancer and found a discontinuation rate of 5.3% [9].…”