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National disparities in treatment package time for resected locally advanced head and neck cancer and impact on overall survival
Author(s) -
Guttmann David M.,
Kobie Julie,
Grover Surbhi,
Lin Alexander,
Lukens John N.,
Mitra Nandita,
Rhodes Karin V.,
Feng Weiwei,
SwisherMcClure Samuel
Publication year - 2018
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/hed.25091
Subject(s) - medicine , hazard ratio , confidence interval , head and neck cancer , proportional hazards model , radiation therapy , cohort , cancer , cohort study , demography , sociology
Background The purpose of this study was to determine national disparities in head and neck cancer treatment package time (the time interval from surgery through the completion of radiation) and the associated impact on survival. Methods We conducted an observational cohort study using the National Cancer Database of 15 234 patients with resected head and neck cancer who underwent adjuvant radiotherapy from 2004‐2012. Predictors of prolonged package time were identified by multivariable linear regression. Survival outcomes were assessed using a multivariable Cox model. Results Mean package time was 100 days (SD 23). Package time was 7.52 days (95% confidence interval [CI] 6.23‐8.81; P < .001) longer with Medicaid versus commercial insurance. Low income and African American race also predicted for longer package times. All‐cause mortality increased an average of 4% with each 1 week increase in treatment package time (hazard ratio [HR] 1.04; 95% CI 1.03‐1.05; P < .001). Conclusion Significant national socioeconomic disparities exist in treatment package time. Treatment delays in this setting may contribute to worse survival outcomes.