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. 2023 Jul;45(7):1676-1691.
doi: 10.1002/hed.27380. Epub 2023 Apr 27.

Update on adherence to guidelines for time to initiation of postoperative radiation for head and neck squamous cell carcinoma

F Jeffrey Lorenz  1 , Sean S Mahase  1   2 , Joseph Miccio  1   2 , Tonya S King  3 , Sandeep Pradhan  3 , Neerav Goyal  1   3   4
Affiliations

Update on adherence to guidelines for time to initiation of postoperative radiation for head and neck squamous cell carcinoma

F Jeffrey Lorenz et al. Head Neck. 2023 Jul.

Abstract

Background: A prior study reported that over half of patients with HNSCC initiated PORT after 6 weeks from surgery during 2006-2014. In 2022, the CoC released a quality metric for patients to initiate PORT within 6 weeks. This study provides an update on time to PORT in recent years.

Methods: The NCDB and TriNetX Research Network were queried to identify patients with HNSCC who received PORT during 2015-2019 and 2015-2021, respectively. Treatment delay was defined as initiating PORT beyond 6 weeks after surgery.

Results: In NCDB, PORT was delayed for 62% of patients. Predictors of delay included age >50, female sex, black race, nonprivate insurance/uninsured status, lower education, oral cavity site, negative surgical margins, increased postoperative length of stay, unplanned hospital readmissions, IMRT radiation modality, treatment at an academic hospital or in the Northeast, and surgery and radiation at different facilities. In TriNetX, 64% experienced treatment delay. Additional associations with prolonged time to treatment included never married/divorced/widowed marital status, major surgery (neck dissection/free flaps/laryngectomy), and gastrostomy/tracheostomy dependence.

Conclusions: There continue to be challenges to timely initiation of PORT.

Keywords: head and neck cancer; head and neck squamous cell carcinoma; postoperative radiation; quality care; treatment delay.

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Conflict of interest statement

CONFLICT OF INTEREST STATEMENT

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Predictors of PORT delay on multivariable analysis
FIGURE 2
FIGURE 2
Temporal trends in the failure to initiate PORT within 6 weeks of surgery according to year of diagnosis
See this image and copyright information in PMC

References

    1. Institute of Medicine (US) Committee on Quality of Health Care in America. Crossing the Quality Chasm. National Academies Press; 2001. doi:10.17226/10027 - DOI
    1. Pfister DG, Spencer S, Adelstein D, et al. Head and neck cancers, version 2.2020, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2020;18(7):873–898. doi:10.6004/jnccn.2020.0031 - DOI - PubMed
    1. Graboyes EM, Garrett-Mayer E, Sharma AK, Lentsch EJ, Day TA. Adherence to National Comprehensive Cancer Network guidelines for time to initiation of postoperative radiation therapy for patients with head and neck cancer. Cancer. 2017;123(14):2651–2660. doi:10.1002/cncr.30651 - DOI - PubMed
    1. Noyes EA, Burks CA, Larson AR, Deschler DG. An equity-based narrative review of barriers to timely postoperative radiation therapy for patients with head and neck squamous cell carcinoma. Laryngosc Investig Otolaryngol. 2021;6(6):1358–1366. doi:10.1002/lio2.692 - DOI - PMC - PubMed
    1. Janz TA, Kim J, Hill EG, et al. Association of care processes with timely, equitable postoperative radiotherapy in patients with surgically treated head and neck squamous cell carcinoma. JAMA Otolaryngol Neck Surg. 2018;144(12):1105–1114. doi:10.1001/jamaoto.2018.2225 - DOI - PMC - PubMed

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