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Treatment delays in laryngeal squamous cell carcinoma: A national cancer database analysis
Author(s) -
Morse Elliot,
Fujiwara Rance J.T.,
Judson Benjamin,
Mehra Saral
Publication year - 2018
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.27247
Subject(s) - medicine , hazard ratio , proportional hazards model , radiation therapy , cancer , logistic regression , surgery , confidence interval
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