Differences in the association of time to treatment initiation and survival according to various head and neck cancer sites in a nationwide cohort

Michaël H Frank; Boukje A C van Dijk; Rosanne C Schoonbeek; Jaap Zindler; Lot A Devriese; Robert J J van Es; Matthias A W Merkx; Remco de Bree

doi:10.1016/j.radonc.2024.110107

Differences in the association of time to treatment initiation and survival according to various head and neck cancer sites in a nationwide cohort

Radiother Oncol. 2024 Mar:192:110107. doi: 10.1016/j.radonc.2024.110107. Epub 2024 Jan 21.

Authors

Michaël H Frank¹, Boukje A C van Dijk², Rosanne C Schoonbeek³, Jaap Zindler⁴, Lot A Devriese⁵, Robert J J van Es⁶, Matthias A W Merkx⁷, Remco de Bree⁶

Affiliations

¹ University of Utrecht, Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands; Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research and Development, Utrecht, the Netherlands; Department of Oral and Maxillofacial Surgery, Haaglanden Medical Center, The Hague, the Netherlands. Electronic address: m.frank@haaglandenmc.nl.
² Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research and Development, Utrecht, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands.
³ University of Groningen, Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, Groningen, the Netherlands.
⁴ Department of Radiation Oncology, Haaglanden Medical Center, The Hague, the Netherlands.
⁵ University of Utrecht, Department of Medical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands.
⁶ University of Utrecht, Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands.
⁷ Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research and Development, Utrecht, the Netherlands; Radboud University Nijmegen, IQ Healthcare, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.

PMID: 38262531
DOI: 10.1016/j.radonc.2024.110107

Abstract

Objectives: To assess whether there are differences in the effects of time to treatment interval (TTI) on patient survival for head and neck cancer (HNC) sites in order to provide evidence that can support decision-making regarding prioritizing treatment.

Materials and methods: Patients in the Netherlands with a first primary HNC without distant metastasis between 2010 and 2014 were included for analysis (N = 10,486). TTI was defined as the time from pathologic diagnosis to the start of initial treatment. Overall survival (OS), cox regression analyses and cubic spline hazard models were calculated and visualized.

Results: Overall, the hazard of dying was higher (HR = 1.003; 95 % CI 1.001-1.005) with each additional day until treatment initiation. The pattern, as visualized in cubic spline graphs, differed by site the hazard increased more steeply with increasing TTI for oral cavity cancer. For oropharyngeal and laryngeal cancer, a slight increase commenced after a longer TTI than for oral cavity cancer, while there was hardly an increase in hazard with increasing TTI for hypopharyngeal cancer.

Conclusion: The relationship between longer TTI and decreased survival was confirmed, but slight variations in the pattern of the hazard of dying by TTI by tumour site were observed. These findings could support decisions on prioritizing treatment. However, other aspects such as extent of treatment and quality of life should be investigated further so this can also be included.

Keywords: Cubic spline; Delayed treatment; Head and neck cancer; Overall survival; Time to treatment.

MeSH terms

Head and Neck Neoplasms* / therapy
Humans
Laryngeal Neoplasms*
Mouth Neoplasms*
Proportional Hazards Models
Quality of Life
Time-to-Treatment