← Back to List

Program Number: B141
Session Name: Poster Session

Delays in Starting Timely, Guideline-Adherent Postoperative Radiation Therapy for Patients with Head and Neck Squamous Cell Carcinoma: A Population-Based Study

James D Sullivan, MD; Dauren Adilbay, MD, PHD; William G Albergotti; Jean-Sebastien Anoma, MA, MS; Michael R Bobian; Bhisham Chera; Elizabeth G Hill, PhD; John M Kaczmar; Alexandra Kejner, MD; Jason G Newman; Judith M Skoner; Katherine R Sterba; Evan M Graboyes, MD, MPH, FACS; Medical University of South Carolina

Background: National Comprehensive Cancer Network Guidelines recommend initiation of postoperative radiation therapy (PORT) within 6 weeks of surgery for patients with locally advanced head and neck squamous cell carcinoma (HNSCC). However, greater than 50% of patients experience delays in starting PORT. Although the prevalence and risk factors for delays in the initiation of PORT have been studied at academic centers and among Commission on Cancer-accredited cancer facilities, no studies to date have characterized PORT delays using a population-based sample. Furthermore, geographic variability in timely PORT remains poorly characterized.

Objectives: To characterize the prevalence of delays in starting PORT among patients with HNSCC, factors associated with delays, and geographic variability in delay in population-representative sample from the South Carolina Cancer Registry.

Study Design: Retrospective cohort study.

Setting: Population-based analysis of data from the South Carolina Central Cancer Registry (SCCCR).

Participants: Adults diagnosed with HNSCC treated with curative intent surgery and PORT from 2008 to 2020.

Main Outcome and Measures: The primary outcome measure was PORT delay, defined as the initiation of PORT > 6 weeks (42 days) from surgery. The association of patient-level factors associated with PORT delay were assessed using multivariable logistic regression.

Results: Among 1716 patients with HNSCC undergoing surgery and PORT, 66.4% were <65 years old, 77.7% were male, and 80.5% were White. The most common HNSCC subsite was the oral cavity (44.8%) and 51.6% of patients had AJCC pathologic stage IV disease. The overall rate of PORT delay was 52.9% and median time-to-PORT was 44 days. When stratified by PORT delay status, median time to PORT was 34 days (IQR 29-39) among patients who initiated PORT < 6 weeks of surgery and 55.0 days (IQR 49-68) among those who experienced a PORT delay. On multivariable logistic regression, several factors were associated with delayed PORT, after adjusting for demographic and clinical characteristics. These included having no insurance (OR 1.98; 95% CI 1.25-3.16), Medicaid (OR 2.14; 95% CI 1.33-3.47), or Medicare (OR 1.50; 95% CI 1.03-2.20), compared to private insurance; living in a rural area (OR 1.49; 95% CI 1.08-2.06), compared to an urban area; and pathologic T stage (pT2 OR 2.12; 95% CI 1.25-3.65, pT3 OR 2.47; 95% CI 1.38-4.45, pT4 OR 1.84; 95% CI 1.10-3.14, all compared to pT0). Rates of PORT delay by county of patient residence were highly variable across the state of South Carolina (Figure 1). Among 35 counties in South Carolina with > 10 cases, 60% (21/35) reported PORT delay rates >50%.

Conclusion: In this population-based sample of patients with HNSCC undergoing surgery and PORT, delays are common and show geographic variability. These findings indicate a need to include population-level data when reporting on PORT delay as granular state-level data may provide useful information for head and neck cancer care providers in these geographic areas.

 

 

← Back to List