An analysis of more than 50,000 patients with head and neck squamous cell carcinoma (HNSCC) found that prolonged time to treatment initiation (TTI) was an independent predictor of worse mortality.
Median overall survival for TTI of 67 days or fewer was 71 months compared with 49 months for TTI less than 67 days (P less than .001). For TTI of 46 to 52 days, median overall survival (OS) was 72 months; for TTI of 53 to 67 days, 61 months, and for TTI of greater than 67 days, 47 months (P less than .001).
The results provide strong evidence that “TTI greater than 67 days is too long and should be considered unacceptable,” wrote Dr. Colin Murphy, a radiation oncologist at Fox Chase Cancer Center, Philadelphia, and his colleagues.
“The current analysis suggests that increasing TTI beyond the threshold established in this monograph alters HNSCC survival and represents a public health issue,” the researchers stated (J Clin Onc. 2015 Dec 2. doi: 10.1200/JCO.2015.5906).
Data from the National Cancer Data Base pertained to 51,655 patients with head and neck squamous cell carcinoma, including oral tongue, oropharynx, larynx, and hypopharynx, during 1998-2011; median follow-up time was 84 months.
Academic institutions had significantly higher median TTI (28 days), compared with community programs (22-23 days), probably because of patients transitioning care, which was an independently associated factor in higher TTI. Despite higher median TTI, academic institutions were associated with improved overall survival, compared with community hospitals, as were care transitions.
Despite rapid tumor proliferation in HNSCC that can result in stage progression, 9.6% of all patients in 2011 had TTI of greater than 67 days, and 25% (29% at academic institutions) had TTI of greater than 46 days, another benchmark level identified in the study.
Mortality risk, according to TTI, was greater for patients with stage I or II disease, compared with stage III or IV disease, a finding that may be because of lymph node involvement. Development of nodal disease at stage III is a significant risk factor for mortality.
The investigators note that health systems elsewhere, in Denmark for example, have addressed the problem of prolonged TTI. Such efforts require coordination among providers and mandate expedited appointments for a patients with a new cancer diagnosis.
“Recently piloted programs offering next-day appointments with cancer specialists address this reversible predictor of mortality and may partially alleviate increasing TTI. Without such reforms, it is conceivable that outcomes will continue to worsen because of prolonged TTI,” they wrote.