Prognostic significance of time trends in treatment of head and neck squamous cell carcinoma

• Published in: American journal of otolaryngology Vol. 44; no. 6; p. 103966
• Main Authors: Balchander, Divya, Shorbaji, Khaled, Cabrera, Claudia I., Hoying, David, Clancy, Kate, Fowler, Nicole, Thuener, Jason E., Lavertu, Pierre, Pan, Quintin, Teknos, Theodoros N., Rezaee, Rod P., Li, Shawn, Tamaki, Akina
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2023
• Subjects: COVID-19; Delays in treatment; Head and neck squamous cell carcinoma; Time to treatment initiation; COVID-19; Head and neck squamous cell carcinoma; Delays in treatment; Time to treatment initiation
• ISSN: 0196-0709; 1532-818X
• DOI: 10.1016/j.amjoto.2023.103966

To analyze the impact of demographic, clinical, and management variables on time to treatment initiation (TTI) and overall survival (OS). Retrospective chart review. Medical records of patients diagnosed with head and neck cancer from 2018 to 2020 were reviewed. Univariate linear and Cox-regressions identified predictors of TTI and OS. Kaplan Meier (KM) curves assessed the difference in survival by diagnostic year and TTI. 381 patients met eligibility criteria. Median TTI was 35.0 days (IQR: 25.0–49.0). Only 10.8 % of all patients reported any treatment delay, with TTI exceeding 90 days found in 3.7 % of patients. TTI increased with African American race (p = 0.02), ED referrals (p = 0.02), and direct admission status (p = 0.01). When compared to treatment with surgery alone, TTI was shorter in patients undergoing surgery with adjuvant radiation (p = 0.02), adjuvant chemoradiation (p = 0.04), and salvage surgery (p = 0.04). Univariate Cox-regressions found smoking (p = 0.01), direct admission status (p = 0.02), increased duration of symptoms (p = 0.02), placement of PEG tubes (p < 0.01) and tracheostomies (p < 0.01), combination treatment (p < 0.01), and surgery with adjuvant chemoradiation treatment (p = 0.01) to increase mortality risk. Disease characteristics, including tumor size (p < 0.01), presence of nodal disease (p = 0.02), and late-stage disease (p < 0.01), increased mortality risk. TTI and diagnostic year did not impact survival. Our analysis determined several demographic, referral, and treatment factors impacted TTI. However, increased TTI did not impact survival. Characteristics consistent with advanced disease worsened OS. Despite the pandemic burden, patients diagnosed in 2020 showed no difference in short-term survival compared to prior years. •Time to treatment, did not impact overall survival in patients with non-metastatic head and neck squamous cell carcinoma.•Characteristics of advanced disease were found to be predictive of mortality.•Despite the high pandemic burden, HNSCC treatment and overall survival were not impacted by COVID-19.