Author: Leah Lawrence, Contributing Writer
Treatment delayed longer than 2 months from the time of diagnosis negatively affected survival and increased recurrence among patients with head and neck squamous cell carcinoma (HNSCC), a retrospective study found.
Looking at a group of 956 patients treated at a single urban academic center, those with a time to treatment initiation (TTI) longer than 60 days were significantly more likely to die from their disease (odds ratio [OR] 1.69, 95% CI 1.32-2.18) and have disease recurrence (OR 1.77, 95% CI 1.07-2.93) compared to those treated within this timeframe, reported Vikas Mehta, MD, MPH, of Montefiore Medical Center in New York City, and colleagues.
As described in JAMA Otolaryngology–Head & Neck Surgery, the 5-year overall survival for patients dropped from 64.5% to 47.0% when the TTI stretched beyond 60 days.
“If I invented a drug that could give a 20% improved survival in head and neck cancer patients, a disease where survival has not changed for many years, I would probably be getting handed a large amount of funding,” Mehta told MedPage Today.
“This study is just as important,” he continued. “Getting patients to treatment in a timely manner can independently improve survival.”
Initial diagnoses at the treatment institution decreased the odds of TTI delay by almost 50% (OR 0.53, 95% CI 0.37-0.76). However, patients with Medicaid as compared with commercial insurance were significantly more likely to have treatment delays (OR 2.17, 95% CI 1.28-3.66). As were African-American patients and those with a body mass index (BMI) of 18.5.
“Unlike studies that look at things from a national perspective, this study shows that not all populations are created equal,” Mehta said. “For some populations the issue with delays is that the population covers a large geographical area where it is hard for people to travel. In our population, the big issue is socioeconomic and comorbidities.”
In an editorial that accompanied the article, Evan Graboyes, MD, and Chanita Hughes-Halbert, PhD, of the Medical University of South Carolina, wrote that these new data add to an existing body of evidence about delays in HNSCC and the call to “recognize the devastating oncologic consequences of treatment delays.”
Specifically, Graboyes and Hughes-Halbert pointed out that identification of missed appointments (21.2%), extensive pretreatment evaluation (21.2%), and treatment refusal (13.6%) as the three most common reasons for delay are “key to advancing our understanding of HNSCC care delivery.”
However, they cautioned that these results should be seen only as hypothesis generating.
“It is imperative that the science move beyond continuing to characterize the frequency and oncologic consequences of treatment delays and instead focus on identifying and understanding the barriers to timely care at the patient, healthcare provider, and system levels so that we may develop and test novel interventions specifically targeted at these barriers,” Graboyes and Hughes-Halbert wrote.
Mehta agreed with this conclusion, telling MedPage Today that he and colleagues at his cancer center are now beginning work to measure these outcomes in real time.
“We want to have the ability to measure month to month and patient by patient how we are performing in terms of when we diagnose and when we first treat,” Mehta said. “By looking at that benchmark we can begin planning interventions in an organized, quality-improvement-based fashion. Collaborating with other institutions will be key.”
All 956 participants in the retrospective study had primary HNSCC diagnosed from February 2005 to July 2017 and were identified using the Montefiore Medical Center Cancer Registry.
The median TTI among all patients was 40 days. About one-fifth of patients were identified as having a TTI of longer than 60 days and considered to have delayed treatment.