Comparison of treatment delay for head and neck cancer at a tertiary university hospital between 2003, 2008 and 2013

Introduction The influence of the time between the first visit to the specialized head and neck surgeon in a tertiary university cancer and the treatment (treatment delay) of head and neck cancer (HNC) was investigated. The literature is controversial concerning the role of time to treatment initiation (TTI) defined as the number of days between histopathological diagnosis and initiation of treatment on the outcome. Furthermore, the effect of structured multidisciplinary treatment programs in certified HNC centers on TTI is unclear.

Material and Methods In this retrospective cohort study, data from 297 patients (78.8% men; median age: 62 years) with a primary HNC treated 2003, 2008, or 2013 (after establishment of a certified HNC cancer) were analyzed. Univariate and multivariate analyses were performed to examine factors with influence on TTI.

Results Mean TTI in all three cohorts was 22.0 ± 30.7 days. Mean TTI in 2003, 2008, and 2013 was 17.1 ± 18.0, 30.3 ± 30.18 and 17.3 ± 37.0 days, respectively. In univariable analysis on OS, TTI > 5 days was associated with lower OS (p=0.047). In multivariable analysis on OS, risk factors were male gender (p=0.010), higher age (p=0.005) and increased Charlson Comorbidity Index (p < 0.001). A reduction in the HR of death in 2013 compared to 2003 was seen (HR 0.327; 95% CI 0.139 – 0.765; p=0.010). TTI in the three years did not have an influence on OS.

Conclusion TTI > 5 days showed significantly lower OS. There was no clear trend in the impact of treatment delay on OS between 2003, 2008 and 2013, i.e. treatment in a certified HNC center and its more complex requirements had no negative impact on the TTI. The implementation of fast-track programs might be a strategy to reduce TTI.

Publication History

Article published online:
24 May 2022