National treatment times in oropharyngeal cancer treated with primary radiation or chemoradiation

Abstract

Objective: To characterize treatment delays in oropharyngeal cancer treated with radiation in a national sample, identify factors associated with delays, and associate treatment delays with survival.

Materials and methods: We included adults in the National Cancer Database treated for oropharyngeal cancer with primary radiation or chemoradiation 2010-2013. We characterized diagnosis-to-treatment initiation, radiation treatment duration, and diagnosis-to-treatment end intervals as medians. We examined delays for association with patient, tumor, and treatment characteristics and with overall survival with multivariable logistic and Cox proportional hazards regression, respectively.

Results: 4089 patients were included; 12% received radiation alone and 88% chemoradiation. The incidence of human papilloma virus-associated tumors was 64%. Median durations of diagnosis-to-treatment initiation, radiation duration, and diagnosis-to-treatment end were 35, 50, and 87 days, respectively. Human papilloma virus-positive tumors were linked to decreased delays in radiation treatment duration and diagnosis-to-treatment end (OR = 0.72 (0.60-0.85), p < 0.001 and OR = 0.79 (0.66-0.95), p = 0.010, respectively). Delays in radiation treatment duration and diagnosis-to-treatment end were negatively associated with overall survival (HR = 1.23 (1.03-1.47), p = 0.024 and 1.24 (1.04-1.48), p = 0.017, respectively). When examined separately, radiation duration remained associated with decreased overall survival in patients with human papilloma virus-negative (HR = 1.29 (1.03-1.63), p = 0.030) but not human papilloma virus-positive tumors (HR = 1.17 (0.89-1.54), p = 0.257).

Conclusion: These median durations can serve as national benchmarks. Diagnosis-to-treatment end interval is associated with overall survival in all patients, and radiation treatment duration in patients with human papilloma virus-negative tumors. These intervals could be considered quality indicators for oropharyngeal squamous cell carcinoma treated with primary radiation or chemoradiation.

Keywords: Benchmarking; Chemoradiotherapy; Head and neck cancer; Head and neck squamous cell carcinoma; Human Papilloma Virus; Oropharyngeal Cancer; Prognosis; Quality of health care; Treatment delays; Treatment times.