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Laryngoscope. 2018 Dec;128(12):2751-2758. doi: 10.1002/lary.27247. Epub 2018 May 14.

Treatment delays in laryngeal squamous cell carcinoma: A national cancer database analysis.

Author information

1
Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, U.S.A.

Abstract

OBJECTIVE:

To characterize treatment delays in laryngeal cancer and associate delays with patient, tumor, and treatment factors and with overall survival.

METHODS:

We identified 33,819 adults with laryngeal squamous cell carcinoma (LSCC) in the National Cancer Database from 2004 to 2013. We calculated durations of diagnosis-to-treatment initiation, surgery-to-adjuvant treatment, radiotherapy duration, total treatment package, and diagnosis-to-treatment end intervals. Delays were associated with patient, tumor, and treatment characteristics via multivariable logistic regression and with overall survival by Cox proportional hazards regression.

RESULTS:

Median durations of diagnosis-to-treatment initiation, surgery-to-radiation initiation, radiation treatment, total treatment package, and diagnosis-to-treatment end were 28, 42, 48, 91, and 107 days in surgical patients; median durations of diagnosis-to-treatment initiation, radiation treatment, and diagnosis-to-treatment end were 33, 50, and 85 days in nonsurgical patients. Race and insurance status were linked to delays in most intervals. Academic and high-volume facilities had less delayed radiation treatment but increased delays in most other intervals. Delayed surgery-to-radiation and total treatment package intervals were associated with overall survival in surgical patients (hazard ratio [HR] = 1.15 [1.03-1.29], P = 0.015; HR = 1.16 [1.02-1.31], P = 0.025). Diagnosis-to-treatment initiation and diagnosis-to-treatment end intervals were associated with overall survival in nonsurgical patients (HR = 1.08 [1.02-1.14], P = 0.007; HR = 1.09 [1.03-1.16], P = 0.003, respectively) but not in surgical patients (HR = 0.96 [0.87-1.06] P = 0.440; HR = 1.13 [0.99-1.29], P = 0.062). Radiation delays were associated with overall survival in surgical and nonsurgical patients (HR = 1.21 [1.09-1.36], P = 0.001; HR = 1.37 [1.30-1.44], P < 0.001).

CONCLUSION:

These durations can serve as national benchmarks. Delays could be considered quality indicators in LSCC.

LEVEL OF EVIDENCE:

2b Laryngoscope, 128:2751-2758, 2018.

KEYWORDS:

Head and neck cancer; laryngeal squamous cell carcinoma; quality of care; radiotherapy; surgery

PMID:
29756382
DOI:
10.1002/lary.27247
[Indexed for MEDLINE]

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