Time to treatment patterns of head and neck cancer patients before and during the Covid-19 pandemic

Jason Tasoulas; Travis P Schrank; Blaine D Smith; Chris B Agala; Sulgi Kim; Siddharth Sheth; Colette Shen; Wendell G Yarbrough; Trevor Hackman; Christopher Blake Sullivan

doi:10.1016/j.oraloncology.2023.106535

Time to treatment patterns of head and neck cancer patients before and during the Covid-19 pandemic

Oral Oncol. 2023 Nov:146:106535. doi: 10.1016/j.oraloncology.2023.106535. Epub 2023 Aug 23.

Authors

Affiliations

¹ Department of Otolaryngology - Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
² Department of Otolaryngology - Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
³ Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁴ Division of Oncology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁵ Department of Radiation Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁶ Department of Otolaryngology - Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Pathology and Laboratory Medicine, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁷ Department of Otolaryngology - Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: blake_sullivan@med.unc.edu.

PMID: 37625360
DOI: 10.1016/j.oraloncology.2023.106535

Abstract

Objectives: The delivery of healthcare has changed significantly over the past decades. This study analyzes the clinicodemographic factors and treatment patterns of head and neck squamous cell carcinoma (HNSCC) patients between 2004 and 2020.

Materials and methods: Retrospective cohort analysis of HNSCC patients from the National Cancer Data Base from 2004 to 2020.

Results: A total of 164,290 patients were included. Increased times from diagnosis to definitive surgery (TTS) were seen across all facility types (academic centers, AC; non-academic centers, NAC) between 2004 and 2019, with NAC affected more. TTS < 15 days (RR = 1.05, 95%CI:1.05-1.09) and > 75 days (1.07, 95%CI:1.05-1.09) were associated with increased mortality risk. This association was more prominent among HPV + HNSCC (RR = 1.45; 95%CI:1.18-1.78). Treatment in AC was associated with a decreased mortality risk (RR = 0.94, 95%CI:0.93-0.95). Despite the universal increase in wait times from 2004 to 2019, short-term mortality was significantly decreased from 2016 to 2019, relative to 2004-2007 (3-month mortality: RR = 0.77, 95%CI:0.70-0.85; 12-month mortality: RR = 0.80, 95%CI:0.77-0.84). Wait times decreased in 2020.

Conclusions: TTS increased between 2004 and 2019, with NAC affected more. However, despite longer wait times, short-term survival increased significantly. Very short (<15 days) and very long (>75 days) TTS were associated with increased mortality risk. Patients with HPV + HNSCC have the highest increase among those treated > 75 days from diagnosis. Treatment at AC was associated with improved survival, which could be explained by the presence of multidisciplinary teams and subspecialists that may be less available at NAC. The 2021 NCDB data are required for a comprehensive analysis of wait times in 2020.

Keywords: Chemotherapy; Covid-19; Head and neck cancer; Pandemic; Radiation; Time to surgery; Time to treatment.

MeSH terms

COVID-19* / epidemiology
Carcinoma, Squamous Cell* / pathology
Head and Neck Neoplasms* / epidemiology
Head and Neck Neoplasms* / therapy
Humans
Pandemics
Papillomavirus Infections*
Retrospective Studies
Squamous Cell Carcinoma of Head and Neck / therapy
Time-to-Treatment