Source: www.hemonctoday.com
Author: Christen Haigh
No association was found between diagnosis to treatment interval and tumor control outcomes in patients with squamous cell carcinoma of the head and neck (SCCHN). However, patients with poor Karnofsky performance status, black patients and patients treated with intensity-modulated radiation therapy all had prolonged diagnosis to treatment interval.
Jimmy J. Caudell Jr., MD, PhD, assistant professor of radiation oncology at the University of Mississippi, Jackson, presented the findings at the Multidisciplinary Head & Neck Cancer Symposium in Chandler, Ariz.
Prolonged treatment delay from the time of diagnosis may often occur in patients with locoregionally advanced head and neck cancer due to social, dental, nutritional and radiotherapy planning procedures that need to be resolved prior to treatment initiation, according to researchers.
To assess factors affecting treatment delay, researchers analyzed data from 426 patients with SCCHN treated with radiotherapy from 1995 to 2007 at the University of Alabama-Birmingham. The median follow-up was 42 months.
The median diagnosis to treatment interval was 34 days. Longer than median diagnosis to treatment interval was associated with treatment off protocol (P=.002), black ethnicity (P=.005), insurance type (P< .001), lower Karnofsky performance status (P=.003), primary site (P=.01) and use of IMRT (P<.001).
Use of IMRT (P<.001), lower Karnofsky performance status (P=.02) and black ethnicity (P=.04) remained significant for longer diagnosis to treatment interval, in a regression analysis.
Longer diagnosis to treatment interval was not significantly associated, however, with locoregional control (P=.11), distant metastasis-free survival (P=.32) or OS (P=.07). No difference was observed in locoregional control (P=.2) or OS (P=.4), even when the lowest quartile for diagnosis to treatment interval (<24 days) was compared with the highest quartile (>51 days).
“If we can identify these patients or processes to shorten delay to treatment, we may improve patient satisfaction,” Caudell said during a presentation.
Note:
1. Caudell JJ. #13. Presented at: Multidisciplinary Head and Neck Cancer Symposium; Feb. 25-27, 2010; Chandler, Ariz.
March 5th, 2010 at 9:31 pm
By world medical treatment standards a diagnosis to treatment period of about a month is really good. However, I am grossly disappointed in this presentation. I personally find a study which considers 30 days from diagnosis to treatment “prolonged” and to not have a full grasp on things. At OCF, and on the OCF message boards we routinely have poster/patients and callers that are 4-6 months in between the processes. By world standards still not horrible, but by accepted US care standards, well out of the range of acceptable in my mind.
I realize in the defense of the authors that socio-economic issues are not their area of expertise. But their total lack of stating that we have clear issues in our country that leave large areas of poor and under served populations receiving lesser education on medical issues (risk factors would be a prime example), less availability in the black and poor communities of access to medical care let alone early diagnostic screening, and populations with lower economic levels which translate into less ability to get to appropriate early diagnostic and then treatment management, leaves me wondering if they even considered any of this.
They write as if the US is one homogenous, equal opportunity environment, and stating “If we can identify these patients….” amazes me. Go into any undeserved inner city or rural environment and you will find the people that fit your question of who they are - identifying those at risk is not rocket science docs.
And to end all this by stating that identifying them “may improve patient satisfaction” really sits wrong with me, as I daily talk to people who are having worse/increased treatment related morbidity because of delays in diagnosis and treatment, and who are DYING at greater rates that the rest of the population, soly because they are part of thse under served populations. Raising “patient satisfaction” is a ridiculous way of putting this. How about stating this opportunity as raising patient SURVIVAL RATES…. the real issue here. I guarantee you those that are dead, or families who are left behind, are “dissatisfied” with the whole process and their place in it. Seeing them survive will certainly improve their “satisfaction.” There is no question that late diagnosis, and delays in getting to treatment is not always the fault of patients. And it is easily documented by just a cursory look at the SEER numbers that later staging (a result of later discovery and diagnosis as well as treatment delays) yields poorer long term outcomes.