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Rubino F, Brahimaj B, Hanna EY, Su SY, Phan J, Grosshans DR, DeMonte F, Raza SM. Does Time to Initiation of Adjuvant Radiotherapy Affect Reconstruction Outcomes after Endoscopic Resection of Skull Base Malignancies? J Neurol Surg B Skull Base 2024; 85:445-457. [PMID: 39228888 PMCID: PMC11368463 DOI: 10.1055/a-2114-4563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/19/2023] [Indexed: 09/05/2024] Open
Abstract
Introduction and Objective It is unclear if the length of the time interval to initiation of adjuvant radiation therapy (RT) after endoscopic endonasal surgery affects reconstruction outcomes. In this study we present our experience with adjuvant RT after endoscopic endonasal procedures, to determine if the time to RT after surgery impacts post-RT reconstruction complication rates. Methods A retrospective cohort study of 164 patients who underwent endoscopic endonasal surgery between 1998 and 2021 was conducted. Using Cox proportional hazard ratios (HRs), we evaluated several variables and the complications that occurred during the 1-year period after starting RT. Results Seventy-eight (47.5%) and eighty-six patients (52.5%) received RT before and after the sixth postoperative week, respectively. The overall post-RT complication rates were 28%, most of these were severe infections ( n = 20, 12.2%) and delayed CSF leak ( n = 4, 2.5%). There was no significant difference in the post-RT complications between the patients who received postoperative RT before or after the sixth operative week (HR: 1.13; 95% confidence interval: 0.63-2.02; p = 0.675 ). Univariate analysis demonstrated negative impact associated with smoking history ( p = 0.015 ), the use of neoadjuvant chemotherapy ( p = 0.0001 ), and the use of photon therapy ( p = 0.012 ); and we found a positive impact with the use of multilayer reconstruction techniques (overall, p = 0.041 ; with fat, p = 0.038 ; and/or fascia graft, p = 0.035 ). After a multivariate analysis only, smoking history was an independent risk factor for post-RT complications ( p = 0.012 ). Conclusion Delaying RT for more than 6 weeks after endoscopic endonasal surgery does not provide a significant benefit for reconstruction outcomes. However, special attention may be warranted in patients with smoking history who have received neoadjuvant chemotherapy, or in patients who will receive photon-based RT after surgery as these groups were found to have increased complication rates post-RT.
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Affiliation(s)
- Franco Rubino
- Division of Surgery, Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Bledi Brahimaj
- Division of Surgery, Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Ehab Y. Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Shirley Y. Su
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Jack Phan
- Division of Radiation Oncology, Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - David R. Grosshans
- Division of Radiation Oncology, Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Franco DeMonte
- Division of Surgery, Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Shaan M. Raza
- Division of Surgery, Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
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Akhtar S, Tariq M, Shamsi B, Abrar S, Qureshi BM, Hafiz A, Ali N, Abbasi AN. In Regard to Ethan B. Ludmir et al. Pract Radiat Oncol 2024; 14:464-465. [PMID: 39218528 DOI: 10.1016/j.prro.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 03/08/2024] [Indexed: 09/04/2024]
Affiliation(s)
- Sarah Akhtar
- Section of Radiation Oncology, Aga Khan University Hospital, Karachi, Pakistan.
| | - Maria Tariq
- Section of Radiation Oncology, Aga Khan University Hospital, Karachi, Pakistan
| | - Bareera Shamsi
- Section of Radiation Oncology, Aga Khan University Hospital, Karachi, Pakistan
| | - Sehrish Abrar
- Section of Radiation Oncology, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Asim Hafiz
- Section of Radiation Oncology, Aga Khan University Hospital, Karachi, Pakistan
| | - Nasir Ali
- Section of Radiation Oncology, Aga Khan University Hospital, Karachi, Pakistan
| | - Ahmed Nadeem Abbasi
- Section of Radiation Oncology, Aga Khan University Hospital, Karachi, Pakistan
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Lazzari G, Benevento I, Montagna A, D’Andrea B, De Marco G, Castaldo G, Bianculli A, Tucciariello R, Metallo V, Solazzo AP. Breast Cancer Adjuvant Radiotherapy in Up-Front to Chemotherapy: Is There a Worthwhile Benefit? A Preliminary Report. BREAST CANCER (DOVE MEDICAL PRESS) 2024; 16:359-367. [PMID: 39050764 PMCID: PMC11268516 DOI: 10.2147/bctt.s471345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 06/27/2024] [Indexed: 07/27/2024]
Abstract
Purpose We administered a new breast cancer (BC) adjuvant therapy sequence that delivered postoperative radiotherapy (PORT) before chemotherapy (CT). Our aim was to assess the gain in time to start PORT and the G2-G3 acute-subacute toxicity rate of whole breast adjuvant hypofractionated radiotherapy (AH-RT) administered up-front to the third-generation adjuvant CT (A-CT) in high-risk nodal positive BC in a preliminary report at 2 years. Methods This retrospective study analysed the duration of treatment and safety of AH-RT administered up-front to A-CT in high-risk nodal positive BC patients (pts). Data on 45 pts treated between 2022-2023 were collected. All pts underwent the third-generation A-CT after AH-RT 15-5 fractions with or without a boost. Acute toxicity was scored according to CTCAE v5.0 for skin, pulmonary, and cardiac adverse events. Univariate and multivariate analyses were conducted to assess significant prognosticators for skin/lung/heart acute toxicities in the AH-RT 5-15 fractions arms and CT (p < 0.005). Results A reduction in the time to PORT initiation and overall adjuvant treatment time was recorded. RT was initiated 5 median weeks after surgery, and A-CT was performed 9 median weeks after surgery. The median duration of the entire adjuvant treatment was 35 weeks after surgery. At 6 months mean follow-up, no significant differences in G2-G3 toxicity were noted between the different hypofractionated RT arms, irrespective of the CT schedules, irradiated volumes, or boost (SIB or sequential) in univariate and multivariate analyses. In the multivariate analysis, no significant effects in CT schedules and AH-RT 5-15 arms for skin/lung acute toxicities (p = 0.077 and p = 0.68; 0.67 and 0.87, respectively) were recorded. Conclusion As a new PORT approach in BC, AH-RT up-front to the third-generation A-CT appeared safe with a low acute toxicity profile, providing an advantage in shortening the time from surgery to PORT initiation and the overall adjuvant treatment time.
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Affiliation(s)
- Grazia Lazzari
- Radiation Oncology Unit, IRCCS, CROB, Rionero in Vulture, PZ, Italy
| | - Ilaria Benevento
- Radiation Oncology Unit, IRCCS, CROB, Rionero in Vulture, PZ, Italy
| | | | - Barbara D’Andrea
- Radiation Oncology Unit, IRCCS, CROB, Rionero in Vulture, PZ, Italy
| | | | | | - Antonella Bianculli
- Physic Unit, Radiation Oncology Unit, IRCCS, CROB, Rionero in Vulture, PZ, Italy
| | | | - Vito Metallo
- Radiation Oncology Unit, IRCCS, CROB, Rionero in Vulture, PZ, Italy
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Yan P, Shen J, Basavatia A, Garg MK, Tomé WA. Design and implementation of automated notification systems and an electronic whiteboard for radiation therapy planning monitoring. J Appl Clin Med Phys 2024; 25:e14344. [PMID: 38615273 PMCID: PMC11087160 DOI: 10.1002/acm2.14344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/24/2024] [Accepted: 02/23/2024] [Indexed: 04/15/2024] Open
Abstract
PURPOSE Radiotherapy (RT) treatment and treatment planning is a complex process prepared and delivered by a multidisciplinary team of specialists. Efficient communication and notification systems among different team members are therefore essential to ensure the safe, timely delivery of treatments to patients. METHOD To address this issue, we developed and implemented automated notification systems and an electronic whiteboard to track every CT simulation, contouring task, the new-start schedule, and physician's appointments and tasks, and notify team members of overdue and missing tasks and appointments. The electronic whiteboard was developed to have a straightforward view of current patients' planning workflow and to help different team members coordinate with each other. The systems were implemented and have been used at our center to monitor the progress of treatment-planning tasks for over 2 years. RESULTS The last-minute plans were relatively reduced by about 40% in 2023 compared to 2021 and 2022 with a p-value < 0.05. The overdue contouring tasks of more than 1 day decreased from 46.8% in 2019 and 33.6% in 2020 to 20%-26.4% in 2021-2023 with a p-value < 0.05 after the implementation of the notification system. The rate of plans with 1-3 day planning time decreased by 20.31%, 39.32%, and 24.08% with a p-value < 0.05 and the rate of plans with 1-3 day planning time due to the contouring task overdue more than 1 day decreased by 49.49%, 56.89%, and 46.52% with a p-value < 0.05 after the implementation. The rate of outstanding appointments that are overdue by more than 7 days decreased by more than 5% with a p-value < 0.05 following the implementation of the system. CONCLUSIONS Our experience shows that this system requires minimal human intervention, improves the treatment planning workflow and process by reducing errors and delays in the treatment planning process, positively impacts on-time treatment plan completion, and reduces the need for compressed or rushed treatment planning timelines.
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Affiliation(s)
- Ping Yan
- Radiation OncologyMontefiore Medical CenterBronxNew YorkUSA
- Radiation OncologyAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Jin Shen
- Radiation OncologyMontefiore Medical CenterBronxNew YorkUSA
| | - Amar Basavatia
- Radiation OncologyMontefiore Medical CenterBronxNew YorkUSA
| | - Madhur K. Garg
- Radiation OncologyMontefiore Medical CenterBronxNew YorkUSA
- Radiation OncologyAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Wolfgang A. Tomé
- Radiation OncologyMontefiore Medical CenterBronxNew YorkUSA
- Radiation OncologyAlbert Einstein College of MedicineBronxNew YorkUSA
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Feyisa JD, Woldegeorgis MA, Zingeta GT, Abegaz KH, Berhane Y. Cervical Cancer Progression in Patients Waiting for Radiotherapy Treatment at a Referral Center in Ethiopia: A Longitudinal Study. JCO Glob Oncol 2023; 9:e2200435. [PMID: 37216623 PMCID: PMC10497299 DOI: 10.1200/go.22.00435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/03/2023] [Accepted: 03/20/2023] [Indexed: 05/24/2023] Open
Abstract
PURPOSE Nonmetastatic cervical cancer is curable and can be treated with radiotherapy (RT). A delay in receiving treatment because of long waiting times results in upstaging of the disease stage and negatively affects the treatment outcomes. However, real-world evidence that progression occurs while waiting for treatment is scarce in low-income countries. We evaluated the impact of long waiting times for RT in patients with cervical cancer at a referral center in Ethiopia. METHODS A longitudinal study was conducted from January 5, 2019, to May 30, 2020, to address the objectives of this study. Patients with pathologically diagnosed cervical cancer with stage IIB to stage IVA were included in the study. We used Kaplan-Meier analysis to assess overall survival with time. Multivariate Cox regression analysis, using the backward likelihood ratio selection method, was used to fit the final model. RESULTS The median waiting time for radical RT after diagnosis was 477 days. Waiting for more than 51 days for RT results in disease progression. Of the 115 patients included in this study, 59 (51.3%) died during the study period. A delay in waiting (adjusted hazard ratio, 3; 95% CI, 1.7 to 4.9) was significantly associated with disease progression and decreased survival. CONCLUSION Waiting time to receive RT is very long. Urgent action is required to significantly reduce waiting times and improve the survival of patients with cervical cancer.
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Affiliation(s)
- Jilcha D. Feyisa
- Department of Oncology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
- Department of Oncology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Girum T. Zingeta
- Department of Oncology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kedir H. Abegaz
- Department of Biostatistics & Health Informatics, Madda Walabu University, Robe, Ethiopia
| | - Yemane Berhane
- Department of Epidemiology and Biostatics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
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Bhandari S, Wadhwa Soni B, Gupta A, Ghoshal S. Time required for prophylactic oral care in head and neck cancer patients scheduled for radiotherapy: A single center, prospective cohort study. Head Neck 2023; 45:913-920. [PMID: 36794635 DOI: 10.1002/hed.27317] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/21/2023] [Accepted: 02/05/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Prophylactic oral care (POC) before radiotherapy (RT) is an adjunct but an integral process toward preparing patients for RT, however, time to be invested in POC remains unexplored. METHODS Prospective treatment records were maintained in head and neck cancer patients, who received POC following a standardized protocol with definite timelines. Data collected for oral treatment time (OTT), interruption in RT due to oro-dental issues, future extraction(s), and incidence of osteoradionecrosis (ORN) up to 18 months after treatment were analyzed. RESULTS Three hundred thirty-three patients, 275 males and 58 females, mean age 52.45 ± 11.2 years were included. Mean OTT was 21.0 ± 6.2 days and was influenced significantly with the number of extractions (p < 0.00). There was no interruption in RT schedule due to oro-dental issues. Five patients were diagnosed with ORN. CONCLUSION Performing POC as demonstrated aid in timely removal of nidus of infection(s), perform RT as scheduled, and maintain satisfactory oral health through the survivorship of patients.
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Affiliation(s)
- Sudhir Bhandari
- Unit of Prosthodontics, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhavita Wadhwa Soni
- Unit of Prosthodontics, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankita Gupta
- Department of Radiation Oncology, Advanced Centre for Treatment, Research, and Education in Cancer, Tata Memorial Centre, HBNI, Navi Mumbai, India
| | - Sushmita Ghoshal
- Department of Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Lemma F, Parrino D, Bissolotti G, Emanuelli E, DI Carlo R, Fusetti S. Impact of the SARS-CoV-2 pandemic on the diagnostic delay of oral carcinoma: a retrospective analysis. Minerva Dent Oral Sci 2022; 71:308-317. [PMID: 36760200 DOI: 10.23736/s2724-6329.22.04645-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND The aim of the present study was to investigate how the organisation of healthcare activity during the first wave of the SARS-CoV-2 pandemic affected the timing of diagnosis of oral carcinoma in the Functional Head and Neck Department of Padua (Italy). This study gives an effective temporal dimension of the diagnostic delay that occurred during the pandemic, compared with data from the literature. METHODS A retrospective analysis of the diagnostic path of a patient affected by oral cancer during COVID-19 pandemic was performed. The time elapsed from the patient's awareness of the problem to the first curative surgical intervention was considered both during the blockage of elective care activities and in the period immediately following. The results were compared to a group of patients treated in the same period of the year 2019. RESULTS The territorial time was 53.9% longer in the post-lockdown period than in the lockdown period (39.6 days) while the hospital time was 56.6% shorter than in the post-lockdown period (56 days). CONCLUSIONS The response time of territorial medicine has been longer during the pandemic peak. The unintentional creation of exclusive pathways for oncological patients speeded up the diagnostic process. The organization and accessibility of operating theatres can become particularly problematic during the acute phases of a pandemic.
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Affiliation(s)
- Francesco Lemma
- Department of Maxillofacial Surgery, University of Padua, Padua, Italy - .,Section of Otolaryngology, Department of Neuroscience (DNS), University of Padua, Padua, Italy -
| | - Daniela Parrino
- Department of Maxillofacial Surgery, University of Padua, Padua, Italy.,Section of Otolaryngology, Department of Neuroscience (DNS), University of Padua, Padua, Italy
| | - Guido Bissolotti
- Department of Maxillofacial Surgery, University of Padua, Padua, Italy.,Section of Otolaryngology, Department of Neuroscience (DNS), University of Padua, Padua, Italy
| | - Enzo Emanuelli
- Department of Maxillofacial Surgery, University of Padua, Padua, Italy.,Section of Otolaryngology, Department of Neuroscience (DNS), University of Padua, Padua, Italy
| | - Roberto DI Carlo
- Department of Maxillofacial Surgery, University of Padua, Padua, Italy.,Section of Otolaryngology, Department of Neuroscience (DNS), University of Padua, Padua, Italy
| | - Stefano Fusetti
- Department of Maxillofacial Surgery, University of Padua, Padua, Italy.,Section of Otolaryngology, Department of Neuroscience (DNS), University of Padua, Padua, Italy
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Qureshi BM, Tariq M, Khan AMH, Ali N, Hafiz A, Abrar S, Abbasi AN. In Regard to Hesse et al. Adv Radiat Oncol 2022; 7:100963. [PMID: 35865373 PMCID: PMC9294982 DOI: 10.1016/j.adro.2022.100963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Jiang YT, Chen KH, Yang J, Liang ZG, Qu S, Li L, Zhu XD. Prognostic significance of wait time for radical radiotherapy in locoregionally advanced nasopharyngeal carcinoma. Head Neck 2022; 44:1182-1191. [PMID: 35218120 DOI: 10.1002/hed.27011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/26/2022] [Accepted: 02/14/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The prognostic significance of wait time between definite diagnosis and initial radical radiotherapy is not well established in patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC) receiving both induction chemotherapy (IC) and concurrent chemoradiotherapy (CCRT). METHODS From 2010 to 2018, 648 patients with LA-NPC treated with IC followed by CCRT were included. RESULTS A total of 172 pairs of patients with LA-NPC were selected by propensity score matching (PSM). Compared to patients with an acceptable wait time (≤75 days), patients with a prolonged wait time (>75 days) had a significant lower 5-year DMFS rate (86.6% vs. 74.1%, p = 0.006). Subgroup analyses indicated that the unfavorable effects of longer waiting times were mainly seen among stage IVa patients. CONCLUSIONS A prolonged wait time (>75 days) between definite diagnosis and initial radical radiotherapy has negative prognostic effects on patients with LA-NPC receiving IC plus CCRT, particularly those with IVa stage.
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Affiliation(s)
- Yu-Ting Jiang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Kai-Hua Chen
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Jie Yang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Zhong-Guo Liang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Song Qu
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Ling Li
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Xiao-Dong Zhu
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, China.,Department of Radiation Oncology, Affiliated Wuming Hospital of Guangxi Medical University, Nanning, China
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Abstract
Objective Delay in the diagnosis of head and neck cancer can result in significant excess morbidity and mortality. How the pandemic has affected patient presentation in Scotland is unknown. Method This retrospective cohort study compared all presentations of head and neck cancer between June and October of 2019 with the same period following the peak of the pandemic in 2020 in West Scotland, a region populated by 2.5 million people. Results A total of 528 patients met our inclusion criteria. Compared with 2019, patients in 2020 were more likely to present with a higher American Joint Committee on Cancer stage (odds ratio, 1.67 (95 per cent confidence interval = 1.20 to 2.31); p = 0.002), a longer preceding symptom duration (odds ratio, 2.03 (95 per cent confidence interval = 1.44 to 2.87; p < 0.001) and to have an emergency presentation (odds ratio, 2.53, (95 per cent confidence interval = 1.15 to 5.55; p = 0.017). Conclusion Patients are presenting later with more advanced head and neck cancer following the coronavirus disease 2019 pandemic.
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11
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Patel V, Kwok J, Burke M, Urbano TG, Fenlon M. Should the HPV positive oropharyngeal cancer patient be considered for a two-stage dental assessment for their radiation treatment? Radiother Oncol 2021; 164:232-235. [PMID: 34624407 DOI: 10.1016/j.radonc.2021.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
Patients due to commence head and neck radiation treatment are expected to undergo a dental assessment and be deemed 'dentally fit'. Though this intervention is welcomed by the dental fraternity it is not without its challenges especially in human papilloma virus (HPV) related oropharyngeal cancer (OPC) which has seen a phenomenal rise over the past decade. This perspective piece presents these challenges and proposes a potential adaption of the dental assessment for HPV OPC patients though not necessarily exclusive to this tumour sub-site.
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Affiliation(s)
- Vinod Patel
- Guy's & St Thomas' Hospital Oral Surgery Dept, London, UK.
| | - Jerry Kwok
- Guy's & St Thomas' Hospital Oral Surgery Dept, London, UK.
| | - Mary Burke
- Guy's & St Thomas' Hospital Sedation & Special Care Dept, London, UK.
| | - Teresa Guerrero Urbano
- Guy's & St Thomas' NHS Trust and King's College London, Oncology Department, London, UK.
| | - Michael Fenlon
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK.
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Ponduri A, Liao DZ, Schlecht NF, Rosenblatt G, Prystowsky MB, Kabarriti R, Garg M, Ow TJ, Schiff BA, Smith RV, Mehta V. Impact of Nonadherence to NCCN Adjuvant Radiotherapy Initiation Guidelines in Head and Neck Squamous Cell Carcinoma in an Underserved Urban Population. J Natl Compr Canc Netw 2021; 19:1-7. [PMID: 34555804 DOI: 10.6004/jnccn.2021.7007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 01/13/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Nonadherence to NCCN Guidelines during time from surgery to postoperative radiotherapy (S-PORT) can alter survival outcomes in head and neck squamous cell carcinomna (HNSCC). There is a need to validate this impact in an underserved urban population and to understand risk factors and reasons for delay. We sought to investigate the impact of delayed PORT with outcomes of overall survival (OS) in HNSCC, to analyze predictive factors of delayed PORT, and to identify reasons for delay. METHODS We conducted a retrospective cohort study in an urban, community-based academic center. A total of 184 patients with primary HNSCC were identified through the Montefiore Medical Center cancer registry who had been treated between March 1, 2005, and March 8, 2017, and met the inclusion and exclusion criteria. The primary exposure was S-PORT. OS, recurrence, and risk factors and reasons for treatment delay were the main outcomes and measures. RESULTS Among 184 patients with HNSCC treated with PORT, the median S-PORT was 48.5 days (interquartile range, 41-67 days). The S-PORT threshold that optimally differentiated worse OS outcomes was >50 days (46.7% of our cohort; n=86). Independent of other relevant factors, patients with HNSCC and S-PORT >50 days had worse OS (hazard ratio, 2.30; 95% CI, 1.34-3.95) and greater recurrence (odds ratio, 3.51; 95% CI, 1.31-9.39). Predictors of delayed S-PORT included being underweight or obese, prolonged postoperative length of stay, and age >70 years. The most frequent reasons for PORT delay were complications related to surgery (22.09%), unrelated medical comorbidities (18.60%), and nonadherence/missed appointments (6.98%). CONCLUSIONS Delayed PORT beyond 50 days after surgery was associated with decreased OS and greater recurrence. Identification of predictive factors and reasons for treatment delay helps to target at-risk patients and facilitates interventions in underserved populations.
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Affiliation(s)
| | | | - Nicolas F Schlecht
- 2Department of Pathology, and
- 3Department of Epidemiology & Population Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx
- 4Department of Cancer Prevention & Control, Roswell Park Comprehensive Cancer Center, Buffalo
| | | | | | - Rafi Kabarriti
- 5Department of Radiation Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx; and
| | - Madhur Garg
- 5Department of Radiation Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx; and
| | - Thomas J Ow
- 2Department of Pathology, and
- 6Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Bronx, New York
| | - Bradley A Schiff
- 6Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Bronx, New York
| | - Richard V Smith
- 6Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Bronx, New York
| | - Vikas Mehta
- 6Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Bronx, New York
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13
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Zhu D, Wong A, Oh EJ, Ahn S, Wotman M, Sahai T, Bottalico D, Frank D, Tham T. Impact of Treatment Parameters on Racial Survival Differences in Oropharyngeal Cancer: National Cancer Database Study. Otolaryngol Head Neck Surg 2021; 166:1134-1143. [PMID: 34399637 DOI: 10.1177/01945998211035056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate how differences in treatment parameters account for survival differences between races of patients with oropharyngeal squamous cell carcinoma (OPSCC). STUDY DESIGN Retrospective cohort study. SETTING National Cancer Database. METHODS Data of patients with OPSCC undergoing radiation therapy (RT) or concurrent chemoradiation therapy as primary treatment were obtained from the National Cancer Database from 2004 to 2016. We analyzed 4 treatment-related time intervals to determine their impact on survival between races when controlling for human papilloma virus (HPV) status. Cox proportional hazards models, stepwise logistic regressions, covariate adjustments, and propensity score matching were performed. RESULTS A total of 3152 patients were identified (2877 White, 275 Black). In HPV- cases, Black patients with prolonged radiation duration had a significantly worse overall survival as compared with White patients (hazard ratio, 1.77; 95% CI, 1.03-3.05; P = .039). In a logistic regression model, the only covariate that was significantly associated with prolonged RT was facility type. When further adjusted for facility type, the survival difference between Black and White patients with HPV- status and prolonged RT times was no longer significant (hazard ratio, 1.55; 95% CI, 0.90-2.69; P = .116). CONCLUSIONS There is a significant disparity in overall survival between Black and White patients with HPV- OPSCC when RT duration is prolonged. Clinicians should be aware of the negative impact of prolonged RT, especially in Black patients, so that they can attempt to decrease treatment-related time intervals. Facility type was also found to affect the outcomes of patients with OPSCC, and efforts should be made to improve patient access to well-equipped, high-volume facilities.
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Affiliation(s)
- Daniel Zhu
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Amanda Wong
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Eun Jeong Oh
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Seungjun Ahn
- Department of Biostatistics, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Michael Wotman
- Department of Medicine, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Tanmay Sahai
- Department of Hematology and Oncology, Lenox Hill Hospital, New York, New York, USA
| | - Danielle Bottalico
- Department of Otolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Douglas Frank
- Department of Otolaryngology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Tristan Tham
- Department of Otolaryngology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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14
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Dereje N, Addissie A, Worku A, Gebremariam A, Kantelhardt EJ, Assefa M, Jemal A. Association between waiting time for radiotherapy initiation and disease progression among women with cervical cancer in Addis Ababa, Ethiopia. Int J Cancer 2021; 149:1284-1289. [PMID: 33997978 DOI: 10.1002/ijc.33689] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 04/19/2021] [Accepted: 04/29/2021] [Indexed: 12/24/2022]
Abstract
There is shortage of radiotherapy machines in low-income countries, including Ethiopia. Data on adverse effects of this on cancer outcomes are limited, however. Herein, we examined the extent of waiting time for radiotherapy and its association with disease progression based on a prospective cohort study of women diagnosed with stage IA-IVA cervical cancer in Addis Ababa and who were scheduled to receive radiotherapy at Tikur Anbessa Specialized Hospital, the only hospital that provides radiotherapy services in the country. Association was examined using Multivariable mixed effects logistic regression model. Among the 178 women with cervical cancer scheduled for receipt of radiotherapy and with vital status information, 16 deceased (9.0%) while waiting for radiotherapy. For the remaining 162 women who initiated radiotherapy, the median treatment waiting period was 137 days (IQR = 60-234 days), with 74.1% of women waiting for >60 days. Tumor progressed to higher stage for 44.4% of these women. Compared to those women who initiated radiotherapy ≤60 days after diagnostic confirmation, the odds of tumor progression to higher stage was three times higher in those women who initiated radiotherapy between 120-179 days (aOR =3.30, 95%CI: 1.18-9.27) and ≥180 days (aOR =3.06, 95%CI: 1.24-7.52). Waiting period for receipt of radiotherapy among women with cervical cancer is exceedingly long in Addis Ababa, and it is associated with disease progression to higher stages. These findings reinforce the need to expand radiotherapy infrastructure in order to mitigate the undue high burden of the disease in Ethiopia and other parts of Africa.
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Affiliation(s)
- Nebiyu Dereje
- Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia.,Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adamu Addissie
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alem Gebremariam
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.,Department of Public Health, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
| | - Eva Johanna Kantelhardt
- Department of Gynecology, Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle, Halle, Germany
| | - Mathewos Assefa
- Department of Oncology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ahmedin Jemal
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
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15
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Lopes de Castro C, Fundowicz M, Roselló A, Jové J, Deantonio L, Aguiar A, Pisani C, Villà S, Boladeras A, Konstanty E, Kruszyna-Mochalska M, Milecki P, Jurado-Bruggeman D, Lencart J, Modolell I, Muñoz-Montplet C, Aliste L, Torras MG, Puigdemont M, Carvalho L, Krengli M, Guedea F, Malicki J. Results of the IROCA international clinical audit in prostate cancer radiotherapy at six comprehensive cancer centres. Sci Rep 2021; 11:12323. [PMID: 34112863 PMCID: PMC8192927 DOI: 10.1038/s41598-021-91723-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 05/21/2021] [Indexed: 11/24/2022] Open
Abstract
To assess adherence to standard clinical practice for the diagnosis and treatment of patients undergoing prostate cancer (PCa) radiotherapy in four European countries using clinical audits as part of the international IROCA project. Multi-institutional, retrospective cohort study of 240 randomly-selected patients treated for PCa (n = 40/centre) in the year 2015 at six European hospitals. Clinical indicators applicable to general and PCa-specific radiotherapy processes were evaluated. All data were obtained directly from medical records. The audits were performed in the year 2017. Adherence to clinical protocols and practices was satisfactory, but with substantial inter-centre variability in numerous variables, as follows: staging MRI (range 27.5-87.5% of cases); presentation to multidisciplinary tumour board (2.5-100%); time elapsed between initial visit to the radiation oncology department and treatment initiation (42-102.5 days); number of treatment interruptions ≥ 1 day (7.5-97.5%). The most common deviation from standard clinical practice was inconsistent data registration, mainly failure to report data related to diagnosis, treatment, and/or adverse events. This clinical audit detected substantial inter-centre variability in adherence to standard clinical practice, most notably inconsistent record keeping. These findings confirm the value of performing clinical audits to detect deviations from standard clinical practices and procedures.
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Affiliation(s)
- Carla Lopes de Castro
- Instituto Português de Oncologia, Porto, Portugal.
- Department of Radiation Oncology, Instituto Português de Oncologia Francisco Gentil-Porto, Porto, Portugal.
| | | | | | - Josep Jové
- Institut Català d'Oncologia, Badalona, Spain
| | - Letizia Deantonio
- Università degli Studi del Piemonte Orientale (UNIUPO), Novara, Italy
| | - Artur Aguiar
- Instituto Português de Oncologia, Porto, Portugal
| | - Carla Pisani
- Università degli Studi del Piemonte Orientale (UNIUPO), Novara, Italy
| | | | - Anna Boladeras
- Institut Català d'Oncologia, L'Hospitalet, Barcelona, Spain
| | | | - Marta Kruszyna-Mochalska
- Department of Electroradiology, Poznan University of Medical Sciences, Poznan, Poland
- Greater Poland Cancer Centre, Poznan, Poland
| | - Piotr Milecki
- Department of Electroradiology, Poznan University of Medical Sciences, Poznan, Poland
- Greater Poland Cancer Centre, Poznan, Poland
| | | | | | | | | | - Luisa Aliste
- Institut Català d'Oncologia, L'Hospitalet, Barcelona, Spain
| | | | | | | | - Marco Krengli
- Università degli Studi del Piemonte Orientale (UNIUPO), Novara, Italy
| | - Ferran Guedea
- Institut Català d'Oncologia, L'Hospitalet, Barcelona, Spain
| | - Julian Malicki
- Department of Electroradiology, Poznan University of Medical Sciences, Poznan, Poland
- Greater Poland Cancer Centre, Poznan, Poland
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16
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You KY, Zou WL, Ding L, Bi ZF, Yao HR. Large Tumor Size is an Indicator for the Timely Administration of Adjuvant Radiotherapy in Luminal Breast Cancer with Positive Lymph Node. Cancer Manag Res 2021; 13:1325-1332. [PMID: 33603478 PMCID: PMC7884945 DOI: 10.2147/cmar.s293470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/25/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The optimum timing of adjuvant radiotherapy for breast cancer patients who had undergone surgery remains unclear. The present study aimed to identify the clinical factors which could assist the selecting of time interval (TI) between surgery and adjuvant radiotherapy in luminal breast cancer with lymph node metastasis. Patients and Methods This retrospective study included 1054 luminal breast cancer patients with lymph node metastasis, diagnosed between May 2004 and December 2014, and treated with surgery followed by adjuvant therapy. Overall survival (OS) and disease-free survival (DFS) were compared between patients in the short and long TI groups. Multivariate analysis was performed to examine clinical factors associated with DFS. Subgroups analysis was further performed based on the significant predictors of DFS to explore the association of TI and tumor prognosis. Results For the whole group of patients, there was no difference in OS and DFS between patients with long and short TI. Multivariate analysis showed that age, N stage and tumor size were significant predictors of DFS. Subgroup analysis demonstrated that neither age nor N stage were informative in TI selection; in contrast, in patients with large tumors, a short TI was associated with better DFS than a long TI. In patients with small tumors, there was no significant association between TI and tumor prognosis. In the multivariable analysis, TI was independent predictor of DFS and local recurrence-free survival in patients with large tumors. Conclusion Large tumor size is an indicator for the timely administration of adjuvant radiotherapy in luminal breast cancer with positive lymph node.
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Affiliation(s)
- Kai-Yun You
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China.,RNA Biomedical Institute, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China.,Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Wei-Liang Zou
- Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Lin Ding
- Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Zhuo-Fei Bi
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China.,RNA Biomedical Institute, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China.,Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - He-Rui Yao
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China.,RNA Biomedical Institute, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China.,Department of Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China.,Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
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17
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Ng J, Stovezky YR, Brenner DJ, Formenti SC, Shuryak I. Development of a Model to Estimate the Association Between Delay in Cancer Treatment and Local Tumor Control and Risk of Metastases. JAMA Netw Open 2021; 4:e2034065. [PMID: 33502482 PMCID: PMC7841466 DOI: 10.1001/jamanetworkopen.2020.34065] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE The coronavirus disease 2019 (COVID-19) pandemic has led to treatment delays for many patients with cancer. While published guidelines provide suggestions on which cases are appropriate for treatment delay, there are no good quantitative estimates on the association of delays with tumor control or risk of new metastases. OBJECTIVES To develop a simplified mathematical model of tumor growth, control, and new metastases for cancers with varying doubling times and metastatic potential and to estimate tumor control probability (TCP) and metastases risk as a function of treatment delay interval. DESIGN, SETTING, AND PARTICIPANTS This decision analytical model describes a quantitative model for 3 tumors (ie, head and neck, colorectal, and non-small cell lung cancers). Using accepted ranges of tumor doubling times and metastatic development from the clinical literature from 2001 to 2020, estimates of tumor growth, TCP, and new metastases were analyzed for various treatment delay intervals. MAIN OUTCOMES AND MEASURES Risk estimates for potential decreases in local TCP and increases in new metastases with each interval of treatment delay. RESULTS For fast-growing head and neck tumors with a 2-month treatment delay, there was an estimated 4.8% (95% CI, 3.4%-6.4%) increase in local tumor control risk and a 0.49% (0.47%-0.51%) increase in new distal metastases risk. A 6-month delay was associated with an estimated 21.3% (13.4-30.4) increase in local tumor control risk and a 6.0% (5.2-6.8) increase in distal metastases risk. For intermediate-growing colorectal tumors, there was a 2.1% (0.7%-3.5%) increase in local tumor control risk and a 2.7% (2.6%-2.8%) increase in distal metastases risk at 2 months and a 7.6% (2.2%-14.2%) increase in local tumor control risk and a 24.7% (21.9%-27.8%) increase in distal metastases risk at 6 months. For slower-growing lung tumors, there was a 1.2% (0.0%-2.8%) increase in local tumor control risk and a 0.19% (0.18%-0.20%) increase in distal metastases risk at 2 months, and a 4.3% (0.0%-10.6%) increase in local tumor control risk and a 1.9% (1.6%-2.2%) increase in distal metastases risk at 6 months. CONCLUSIONS AND RELEVANCE This study proposed a model to quantify the association of treatment delays with local tumor control and risk of new metastases. The detrimental associations were greatest for tumors with faster rates of proliferation and metastasis. The associations were smaller, but still substantial, for slower-growing tumors.
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Affiliation(s)
- John Ng
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York
| | | | - David J. Brenner
- Center for Radiological Research, Columbia University Irving Medical Center, New York, New York
| | - Silvia C. Formenti
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York
| | - Igor Shuryak
- Center for Radiological Research, Columbia University Irving Medical Center, New York, New York
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18
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Lakomy R, Kazda T, Selingerova I, Poprach A, Pospisil P, Belanova R, Fadrus P, Smrcka M, Vybihal V, Jancalek R, Kiss I, Muckova K, Hendrych M, Knight A, Sana J, Slampa P, Slaby O. Pre-Radiotherapy Progression after Surgery of Newly Diagnosed Glioblastoma: Corroboration of New Prognostic Variable. Diagnostics (Basel) 2020; 10:E676. [PMID: 32899528 PMCID: PMC7555958 DOI: 10.3390/diagnostics10090676] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The aim of this retrospective study is to assess the incidence, localization, and potential predictors of rapid early progression (REP) prior to initiation of radiotherapy in newly diagnosed glioblastoma patients and to compare survival outcomes in cohorts with or without REP in relation to the treatment. METHODS We assessed a consecutive cohort of 155 patients with histologically confirmed irradiated glioblastoma from 1/2014 to 12/2017. A total of 90 patients with preoperative, postoperative, and planning MRI were analyzed. RESULTS Median age 59 years, 59% men, and 39 patients (43%) underwent gross total tumor resection. The Stupp regimen was indicated to 64 patients (71%); 26 patients (29%) underwent radiotherapy alone. REP on planning MRI performed shortly prior to radiotherapy was found in 46 (51%) patients, most often within the surgical cavity wall, and the main predictor for REP was non-radical surgery (p < 0.001). The presence of REP was confirmed as a strong negative prognostic factor; median overall survival (OS) in patients with REP was 10.7 vs. 18.7 months and 2-year survival was 15.6% vs. 37.7% (hazard ratio HR 0.53 for those without REP; p = 0.007). Interestingly, the REP occurrence effect on survival outcome was significantly different in younger patients (≤ 50 years) and older patients (> 50 years) for OS (p = 0.047) and non-significantly for PFS (p = 0.341). In younger patients, REP was a stronger negative prognostic factor, probably due to more aggressive behavior. Patients with REP who were indicated for the Stupp regimen had longer OS compared to radiotherapy alone (median OS 16.0 vs 7.5; HR = 0.5, p = 0.022; 2-year survival 22.3% vs. 5.6%). The interval between surgery and the initiation of radiotherapy were not prognostic in either the entire cohort or in patients with REP. CONCLUSION Especially in the subgroup of patients without radical resection, one may recommend as early initiation of radiotherapy as possible. The phenomenon of REP should be recognized as an integral part of stratification factors in future prospective clinical trials enrolling patients before initiation of radiotherapy.
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Affiliation(s)
- Radek Lakomy
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, 656 53 Brno, Czech Republic; (R.L.); (A.P.); (I.K.); (J.S.)
- Department of Comprehensive Cancer Care, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
| | - Tomas Kazda
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute, 656 53 Brno, Czech Republic; (P.P.); (P.S.)
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
- Central European Institute of Technology, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic;
| | - Iveta Selingerova
- Research Center for Applied Molecular Oncology, Masaryk Memorial Cancer Institute, 656 53 Brno, Czech Republic;
| | - Alexandr Poprach
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, 656 53 Brno, Czech Republic; (R.L.); (A.P.); (I.K.); (J.S.)
- Department of Comprehensive Cancer Care, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
| | - Petr Pospisil
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute, 656 53 Brno, Czech Republic; (P.P.); (P.S.)
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
| | - Renata Belanova
- Department of Radiology, Masaryk Memorial Cancer Institute, 656 53 Brno, Czech Republic;
- Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
| | - Pavel Fadrus
- Department of Neurosurgery, University Hospital Brno, and Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; (P.F.); (M.S.); (V.V.)
| | - Martin Smrcka
- Department of Neurosurgery, University Hospital Brno, and Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; (P.F.); (M.S.); (V.V.)
| | - Vaclav Vybihal
- Department of Neurosurgery, University Hospital Brno, and Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; (P.F.); (M.S.); (V.V.)
| | - Radim Jancalek
- Department of Neurosurgery, St. Anne’s University Hospital Brno, 656 91 Brno, Czech Republic;
- Department of Neurosurgery, St. Anne’s University Hospital Brno, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
| | - Igor Kiss
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, 656 53 Brno, Czech Republic; (R.L.); (A.P.); (I.K.); (J.S.)
- Department of Comprehensive Cancer Care, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
| | - Katarina Muckova
- Department of Pathology, University Hospital Brno and Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic;
| | - Michal Hendrych
- First Department of Pathology, St. Anne’s University Hospital and Faculty of Medicine, Masaryk University, 656 91 Brno, Czech Republic;
| | - Andrea Knight
- Department of Pathological Physiology, Faculty of Medicine, Gamma Delta T Cell Laboratory, Masaryk University, 625 00 Brno, Czech Republic;
| | - Jiri Sana
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, 656 53 Brno, Czech Republic; (R.L.); (A.P.); (I.K.); (J.S.)
- Department of Comprehensive Cancer Care, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
- Department of Pathology, University Hospital Brno and Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic;
| | - Pavel Slampa
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute, 656 53 Brno, Czech Republic; (P.P.); (P.S.)
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
| | - Ondrej Slaby
- Central European Institute of Technology, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic;
- Department of Biology, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
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19
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Tumba N, Adewuyi SA, Eguzo K, Adenipekun A, Oyesegun R. Radiotherapy waiting time in Northern Nigeria: experience from a resource-limited setting. Ecancermedicalscience 2020; 14:1097. [PMID: 33082847 PMCID: PMC7532027 DOI: 10.3332/ecancer.2020.1097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Indexed: 12/24/2022] Open
Abstract
Background Access and availability of radiotherapy treatment is limited in most low- and middle-income countries, which leads to long waiting times and poor clinical outcomes. The aim of our study is to determine the magnitude of waiting times for radiotherapy in a resource-limited setting. Methods This is a retrospective cohort study of patients with the five most commonly treated cancers managed with radiotherapy between 2010 and 2014. Data includes diagnosis, patients’ demographics and treatment provided. The waiting time was categorised into intervals (1) between diagnosis and first radiation consultation (2) First consultation to radiotherapy treatment (3) Decision-to-treat to treatment and (4) Diagnosis to treatment. Results A total of 258 cases were involved, including cervical (50%; 129/258), breast (27.5%; 71/258), nasopharynx (12.8%; 33/258), colorectal (5%; 13/258) and prostate cancers (4.7%; 12/258). Mean age was 48 (±12.9) years. Treatment with radical intent comprised 67% (178/258) of cases, while 33% (80/258) had palliative treatment. The median time from diagnosis to first radiation consultation was 40 (IQR 17–157.75) days for all the patients, with prostate cancer having the longest time – 305 days (IQR 41–393.8). The median time between the first radiation oncology consultations and first radiotherapy treatment was 130.5 (IQR 14–211.5) days; cervical cancer patients waited a median of 139 (IQR 13–195.5) days. The median time between diagnosis and first radiotherapy for breast cancer patients was 329 (IQR 207–464) days, compared to 213 (IQR 101.5–353.5) days for all the patients. Conclusion The study shows that waiting time for radiotherapy in Nigeria was generally longer than what is recommended internationally. This reflects the need to improve access to radiotherapy in order to improve cancer treatment outcomes in resource-limited settings.
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Affiliation(s)
- Nuhu Tumba
- Department of Radiology, Division of Radiation/Clinical Oncology Bingham University Teaching Hospital, Jos 930214, Nigeria
| | - Sunday Adeyemi Adewuyi
- Department of Radiotherapy & Oncology Ahmadu Bello University Teaching Hospital, Zaria 810105, Nigeria
| | - Kelechi Eguzo
- Department of Obstetrics & Gynaecology, University of Saskatchewan, S4N 2B7, Canada
| | - Adeniyi Adenipekun
- Department of Radiation Oncology, University College Hospital, Ibadan 200284, Nigeria
| | - Rasaaq Oyesegun
- Department of Radiotherapy & Oncology, National Hospital Abuja 900211, Nigeria
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20
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Fundowicz M, Aguiar A, de Castro CL, Torras MG, Deantonio L, Konstanty E, Kruszyna-Mochalska M, Macia M, Canals E, Caro M, Pisani C, Zwierzchowska D, Molero J, Eraso A, Lencart J, Muñoz-Montplet C, Carvalho L, Krengli M, Malicki J, Guedea F. Multicentre clinical radiotherapy audit in rectal cancer: results of the IROCA project. Radiat Oncol 2020; 15:208. [PMID: 32854730 PMCID: PMC7453535 DOI: 10.1186/s13014-020-01648-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/19/2020] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To perform a clinical audit to assess adherence to standard clinical practice for the diagnosis, treatment, and follow-up of patients undergoing radiotherapy for rectal cancer treatment in four European countries. MATERIALS AND METHODS Multi-institutional, retrospective cohort study of 221 patients treated for rectal cancer in 2015 at six European cancer centres. Clinical indicators applicable to general radiotherapy processes were evaluated. All data were obtained from electronic medical records. RESULTS The audits were performed in the year 2017. We found substantial inter-centre variability in adherence to standard clinical practices: 1) presentation of cases at departmental clinical sessions (range, 0-100%) or multidisciplinary tumour board (50-95%); 2) pretreatment MRI (61.5-100%) and thoracoabdominal CT (15.0-100%). Large inter-centre differences were observed in the mean interval between biopsy and first visit to the radiotherapy department (range, 21.6-58.6 days) and between the first visit and start of treatment (15.1-38.8 days). Treatment interruptions ≥ 1 day occurred in 43.9% (2.5-90%) of cases overall. Treatment compensation was performed in 2.1% of cases. Treatment was completed in the prescribed time in 55.7% of cases. CONCLUSIONS This multi-institutional clinical audit revealed that most centres adhered to standard clinical practices for most of the radiotherapy processes-related variables assessed. However, the audit revealed marked inter-centre variability for certain quality indicators, particularly inconsistent record keeping. Multiple targets for improvement and/or harmonisation were identified, confirming the value of routine clinical audits to detect potential deviations from standard clinical practice.
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Affiliation(s)
| | - Artur Aguiar
- Instituto Português de Oncologia; do Porto FG, EPE (IPO-Porto), Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
| | - Carla Lopes de Castro
- Instituto Português de Oncologia; do Porto FG, EPE (IPO-Porto), Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
| | - Maria Glòria Torras
- Institut Català d’Oncologia, L’Hospitalet, Avinguda Granvia de l’Hospitalet, 199-203, 08908 L’Hospitalet de Llobregat, Barcelona, Spain
| | - Letizia Deantonio
- “Amedeo Avogadro” - Rettorato, Università degli Studi del Piemonte Orientale (UNIUPO), via Duomo, 6 - 13100 Vercelli, Novara, Italy
| | | | - Marta Kruszyna-Mochalska
- Greater Poland Cancer Centre, Garbary 15 St, 61-866 Poznan, Poland
- Deparment of Electroradiology, University of Medical Sciences, Fredry 10, 61-701 Poznan, Poland
| | - Miquel Macia
- Institut Català d’Oncologia, L’Hospitalet, Avinguda Granvia de l’Hospitalet, 199-203, 08908 L’Hospitalet de Llobregat, Barcelona, Spain
| | - Eugeni Canals
- Institut Català d’Oncologia, Avinguda de França, S/N 17007, Girona, Spain
| | - Monica Caro
- Institut Català d’Oncologia, Ctra. Canyet s/n 08916, Badalona, Spain
| | - Carla Pisani
- “Amedeo Avogadro” - Rettorato, Università degli Studi del Piemonte Orientale (UNIUPO), via Duomo, 6 - 13100 Vercelli, Novara, Italy
| | | | - Jaume Molero
- Institut Català d’Oncologia, Ctra. Canyet s/n 08916, Badalona, Spain
| | - Arantxa Eraso
- Institut Català d’Oncologia, L’Hospitalet, Avinguda Granvia de l’Hospitalet, 199-203, 08908 L’Hospitalet de Llobregat, Barcelona, Spain
| | - Joana Lencart
- Instituto Português de Oncologia; do Porto FG, EPE (IPO-Porto), Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
| | - Carles Muñoz-Montplet
- Institut Català d’Oncologia, L’Hospitalet, Avinguda Granvia de l’Hospitalet, 199-203, 08908 L’Hospitalet de Llobregat, Barcelona, Spain
| | - Luisa Carvalho
- Instituto Português de Oncologia; do Porto FG, EPE (IPO-Porto), Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
| | - Marco Krengli
- “Amedeo Avogadro” - Rettorato, Università degli Studi del Piemonte Orientale (UNIUPO), via Duomo, 6 - 13100 Vercelli, Novara, Italy
| | - Julian Malicki
- Greater Poland Cancer Centre, Garbary 15 St, 61-866 Poznan, Poland
- Deparment of Electroradiology, University of Medical Sciences, Fredry 10, 61-701 Poznan, Poland
| | - Ferran Guedea
- Institut Català d’Oncologia, L’Hospitalet, Avinguda Granvia de l’Hospitalet, 199-203, 08908 L’Hospitalet de Llobregat, Barcelona, Spain
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21
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Žumer B, Pohar Perme M, Jereb S, Strojan P. Impact of delays in radiotherapy of head and neck cancer on outcome. Radiat Oncol 2020; 15:202. [PMID: 32819389 PMCID: PMC7441656 DOI: 10.1186/s13014-020-01645-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 08/13/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND In head and neck cancer (HNC), the relationship between a delay in starting radiotherapy (RT) and the outcome is unclear. The aim of the present study was to determine the impact of the amount of time before treatment intervention (TTI) and the growth kinetics of individual tumors on treatment outcomes and survival. METHODS Two hundred sixty-two HNC patients with 273 primary tumors, treated with definitive (chemo) RT, were retrospectively analyzed. The TTI was defined as the time interval between the date of histopathologic diagnosis and the first day of the RT course. Volumetric data on 57 tumors were obtained from diagnostic and RT planning computer tomography (CT) scans in order to calculate the tumor growth kinetic parameters. RESULTS No significant association between locoregional control or cause-specific hazards and TTI was found. The log hazard for locoregional recurrence linearly increased during the first 40 days of waiting for RT, although this was not significant. The median tumor volume relative increase rate and tumor volume doubling time was 3.2%/day and 19 days, respectively, and neither had any impact on locoregional control or cause-specific hazards. CONCLUSION The association between a delay in starting RT and the outcome is complex and does not harm all patients waiting for RT. Further research into imaging-derived kinetic data on individual tumors is warranted in order to identify patients at an increased risk of adverse outcomes due to a delay in starting RT.
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Affiliation(s)
- Barbara Žumer
- Department of Radiation Oncology, Institute of Oncology Ljubljana, Zaloška 2, SI-1000, Ljubljana, Slovenia
| | - Maja Pohar Perme
- Institute of Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Simona Jereb
- Department of Radiology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology Ljubljana, Zaloška 2, SI-1000, Ljubljana, Slovenia. .,Chair of Oncology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
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22
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Raphael MJ, Saskin R, Singh S. Association between waiting time for radiotherapy after surgery for early-stage breast cancer and survival outcomes in Ontario: a population-based outcomes study. ACTA ACUST UNITED AC 2020; 27:e216-e221. [PMID: 32489271 DOI: 10.3747/co.27.5629] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background After surgery for early-stage breast cancer (bca), adjuvant radiotherapy (rt) decreases the risk of locoregional recurrence and death from bca. It is unclear whether delays to the initiation of adjuvant rt are associated with inferior survival outcomes. Methods This population-based retrospective cohort study included a random sample of 25% of all women with stage i or ii bca treated with adjuvant rt in Ontario between 1 September 2001 and 31 August 2002, when, because of capacity issues, wait times for radiation were abnormally long. Pathology reports were manually abstracted and deterministically linked to population-level administrative databases to obtain information about recurrence and survival outcomes. Cox proportional hazards modelling was used to evaluate the association between waiting time and survival outcomes. A composite survival outcome was used to ensure that all possible measurable harms of delay would be captured. The composite outcome, event-free survival, included locoregional recurrence, development of metastatic disease, and bca-specific mortality. Results We identified 1028 women with stage i or ii bca who were treated with breast-conserving surgery and adjuvant rt. For the 599 women who were treated with adjuvant radiation without intervening chemotherapy, a waiting time of 12 weeks or more from surgery to the start of radiation appeared to be associated with worse event-free survival after a median follow-up of 7.2 years (hazard ratio for the composite outcome: 1.44; 95% confidence interval: 0.98 to 2.11; p = 0.07). For the 429 women who received intervening adjuvant chemotherapy, a waiting time of 6 weeks or more from completion of chemotherapy to start of radiation was associated with worse event-free survival after a median follow-up of 7.4 years (hazard ratio: 1.50; 95% confidence interval: 1.00 to 2.22; p = 0.047). Conclusions Delay to the initiation of adjuvant rt after breast-conserving surgery is associated with inferior bca survival outcomes. The good prognosis for patients with early-stage bca limits the statistical power to detect an effect of delay to rt. Given that there is no plausible advantage to delay, we agree with Mackillop that time to initiation of rt should be kept "as short as reasonably achievable."
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Affiliation(s)
- M J Raphael
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON
| | | | - S Singh
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON.,ices, Toronto, ON
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23
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Schutte HW, Heutink F, Wellenstein DJ, van den Broek GB, van den Hoogen FJA, Marres HAM, van Herpen CML, Kaanders JHAM, Merkx TMAW, Takes RP. Impact of Time to Diagnosis and Treatment in Head and Neck Cancer: A Systematic Review. Otolaryngol Head Neck Surg 2020; 162:446-457. [PMID: 32093572 DOI: 10.1177/0194599820906387] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE An increased interval between symptomatic disease and treatment may negatively influence oncologic and/or functional outcomes in head and neck cancer (HNC). This systematic review aims to provide insight into the effects of time to treatment intervals on oncologic and functional outcomes in oral cavity, pharyngeal, and laryngeal cancer. DATA SOURCES PubMed, EMBASE, and Cochrane library were searched. REVIEW METHODS All studies on delay or time to diagnosis or treatment in oral, pharyngeal, and laryngeal cancer were included. Quality assessment was performed with an adjusted version of the Newcastle-Ottawa scale. Outcomes of interest were tumor volume, stage, recurrence, survival, patient-reported outcome measures (PROMs), toxicity, and functionality after treatment. RESULTS A total of 51 studies were included. Current literature on the influence of delay in HNC is inconsistent but indicates higher stage and worse survival with longer delay. The effects on PROMs, toxicity, and functional outcome after treatment have not been investigated. The inconsistencies in outcomes were most likely caused by factors such as heterogeneity in study design, differences in the definitions of delay, bias of results, and incomplete adjustment for confounding factors in the included studies. CONCLUSION Irrespective of the level of evidence, the unfavorable effects of delay on oncologic, functional, and psychosocial outcomes are undisputed. Timely treatment while maintaining high-quality diagnostic procedures and decision making reflects good clinical practice in our opinion. This review will pose practical and logistic challenges that will have to be overcome.
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Affiliation(s)
- Henrieke W Schutte
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Floris Heutink
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - David J Wellenstein
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Guido B van den Broek
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Frank J A van den Hoogen
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Henri A M Marres
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Carla M L van Herpen
- Department of Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Johannes H A M Kaanders
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Thijs M A W Merkx
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Robert P Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
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24
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Graboyes EM, Kompelli AR, Neskey DM, Brennan E, Nguyen S, Sterba KR, Warren GW, Hughes-Halbert C, Nussenbaum B, Day TA. Association of Treatment Delays With Survival for Patients With Head and Neck Cancer: A Systematic Review. JAMA Otolaryngol Head Neck Surg 2020; 145:166-177. [PMID: 30383146 DOI: 10.1001/jamaoto.2018.2716] [Citation(s) in RCA: 182] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Delays in the delivery of care for head and neck cancer (HNC) are a key driver of poor oncologic outcomes and thus represent an important therapeutic target. Objective To synthesize information about the association between delays in the delivery of care for HNC and oncologic outcomes. Evidence Review A systematic review of the English-language literature in PubMed/MEDLINE and Scopus published between January 1, 2007, and February 28, 2018, was performed to identify articles addressing the association between treatment delays and oncologic outcomes for patients with HNC. Articles that were included (1) addressed cancer of the oral cavity, oropharynx, hypopharynx, or larynx; (2) discussed patients treated in 2004 or later; (3) analyzed time of diagnosis to treatment initiation (DTI), time from surgery to the initiation of postoperative radiotherapy, and/or treatment package time (TPT; the time from surgery through the completion of postoperative radiotherapy); (4) included a clear definition of treatment delay; and (5) analyzed the association between the treatment time interval and an oncologic outcome measure. Quality assessment was performed using the Institute of Health Economics Quality Appraisal Checklist for Case Series Studies. Findings A total of 18 studies met inclusion criteria and formed the basis of the systematic review. Nine studies used the National Cancer Database and 6 studies were single-institution retrospective reviews. Of the 13 studies assessing DTI, 9 found an association between longer DTI and poorer overall survival; proposed DTI delay thresholds ranged from more than 20 days to 120 days or more. Four of the 5 studies assessing time from surgery to the initiation of postoperative radiotherapy (and all 4 studies assessing guideline-adherent time to postoperative radiotherapy) found an association between a timely progression from surgery to the initiation of postoperative radiotherapy and improved overall or recurrence-free survival. Of the 5 studies examining TPT, 4 found that prolonged TPT correlated with poorer overall survival; proposed thresholds for prolonged TPT ranged from 77 days or more to more than 100 days. Conclusions and Relevance Timely care regarding initiation of treatment, postoperative radiotherapy, and TPT is associated with survival for patients with HNC, although significant heterogeneity exists for defining delayed DTI and TPT. Further research is required to standardize optimal time goals, identify barriers to timely care for each interval, and design interventions to minimize delays.
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Affiliation(s)
- Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston.,Hollings Cancer Center, Medical University of South Carolina, Charleston
| | - Anvesh R Kompelli
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - David M Neskey
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston.,Hollings Cancer Center, Medical University of South Carolina, Charleston.,Department of Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston
| | - Emily Brennan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Shaun Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Katherine R Sterba
- Hollings Cancer Center, Medical University of South Carolina, Charleston.,Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Graham W Warren
- Hollings Cancer Center, Medical University of South Carolina, Charleston.,Department of Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston.,Department of Radiation Oncology, Medical University of South Carolina, Charleston
| | - Chanita Hughes-Halbert
- Hollings Cancer Center, Medical University of South Carolina, Charleston.,Department of Psychiatry, Medical University of South Carolina, Charleston
| | | | - Terry A Day
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
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25
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Franco R, de Matos LL, Kulcsar MAV, de Castro-Júnior G, Marta GN. Influence of time between surgery and postoperative radiation therapy and total treatment time in locoregional control of patients with head and neck cancer: a single center experience. Clinics (Sao Paulo) 2020; 75:e1615. [PMID: 32725072 PMCID: PMC7362720 DOI: 10.6061/clinics/2020/e1615] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/08/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the effect of the delay to initiate postoperative radiation therapy (RT) on locoregional control to head and neck squamous cell carcinoma patients. METHODS Retrospective cohort study that included patients submitted to surgery followed by adjuvant RT (with/without chemotherapy). The time interval between surgery and RT was dichotomized by the receiver operating characteristics curve method at 92 days. Other possible sources of heterogeneity with potential impact on locoregional control were explored by regressive analysis. RESULTS A total of 168 patients were evaluated. The median time for locoregional recurrence (LRR) was 29.7 months. The relapse-free survival rates were 66.4% and 75.4% for patients who initiated RT more than and within 92 postoperative days (p=0.377), respectively. Doses lower than 60Gy were associated with worse rates of locoregional control (HR=6.523; 95%CI:2.266-18.777, p=0.001). Patients whose total treatment time (TTT) was longer than 150 days had LRR rate of 41.8%; no patient with TTT inferior to 150 days had relapses (p=0.001). CONCLUSIONS The interval between surgery and RT did not show influence on locoregional control rates. However, doses <60Gy and the total treatment time >150 days were associated with lower locoregional control rates.
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Affiliation(s)
- Rejane Franco
- Programa de Pos-Graduacao, Departamento de Radiologia e Oncologia, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Hospital de Clinicas, Universidade Federal do Parana, Curitiba, PR, BR
| | - Leandro Luongo de Matos
- Departamento de Cirurgia de Cabeca e Pescoco, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Marco Aurélio Vamondes Kulcsar
- Departamento de Cirurgia de Cabeca e Pescoco, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Gilberto de Castro-Júnior
- Unidade Clinica de Oncologia, Departamento de Radiologia e Oncologia, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Departamento de Oncologia Clinica, Hospital Sirio-Libanes, Sao Paulo, SP, BR
| | - Gustavo Nader Marta
- Departamento de Radiologia e Oncologia, Servico de Radioterapia, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Departamento de Radioterapia, Hospital Sirio-Libanes, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
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26
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Jin MC, Harris JP, Sabolch AN, Gensheimer M, Le QT, Beadle BM, Pollom EL. Proton radiotherapy and treatment delay in head and neck squamous cell carcinoma. Laryngoscope 2019; 130:E598-E604. [PMID: 31837165 DOI: 10.1002/lary.28458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/12/2019] [Accepted: 11/16/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE For patients with head and neck squamous cell carcinoma (HNSCC), delays in the initiation of radiotherapy (RT) have been closely associated with worse outcomes. We sought to investigate whether RT modality (proton vs. photon) is associated with differences in the time to initiation of RT. METHODS The National Cancer Database was queried for patients diagnosed with nonmetastatic HNSCC between 2004 and 2015 who received either proton or photon RT as part of their initial treatment. Wilcoxon rank-sum and chi-square tests were used to compare continuous and categorical variables, respectively. Multivariable logistic regression was used to determine the association between use of proton RT and delayed RT initiation. RESULTS A total of 175,088 patients with HNSCC receiving either photon or proton RT were identified. Patients receiving proton RT were more likely to be white, reside in higher income areas, and have private insurance. Proton RT was associated with delayed RT initiation compared to photon RT (median 59 days vs. 45, P < 0.001). Receipt of proton therapy was independently associated with RT initiation beyond 6 weeks after diagnosis (adjusted OR [aOR, definitive RT] = 1.69; 95% confidence interval [CI] 1.26-2.30) or surgery (aOR [adjuvant RT] = 4.08; 95% CI 2.64-6.62). In the context of adjuvant proton RT, increases in treatment delay were associated with worse overall survival (weeks, adjusted hazard ratio = 1.099, 95% CI 1.011-1.194). CONCLUSION Use of proton therapy is associated with delayed RT in both the definitive and adjuvant settings for patients with HNSCC and could be associated with poorer outcomes. LEVEL OF EVIDENCE 2b Laryngoscope, 122:0000-0000, 2019 Laryngoscope, 130:E598-E604, 2020.
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Affiliation(s)
- Michael C Jin
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford
| | - Jeremy P Harris
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford.,Palo Alto Veterans Affairs Health Care System, Palo Alto, California
| | - Aaron N Sabolch
- The Center for Health Research and the Department of Radiation Oncology, Kaiser Permanente, Portland, Oregon, U.S.A
| | - Michael Gensheimer
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford
| | - Beth M Beadle
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford
| | - Erqi L Pollom
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford.,Palo Alto Veterans Affairs Health Care System, Palo Alto, California
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27
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Roldan CS, Chen JJ, Fareed MM, Hameed MY, Churilla TM, Lango MN, Galloway TJ. Impact of primary tumor-specific growth rate on treatment failure for nonoropharyngeal head and neck cancers. Laryngoscope 2019; 130:2378-2384. [PMID: 31714626 DOI: 10.1002/lary.28393] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/26/2019] [Accepted: 10/10/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To investigate the prognostic impact of primary tumor-specific growth rate (TSGR) on treatment outcomes after definitive radiation therapy (RT) for nonoropharyngeal squamous cell carcinoma (non-OPSCC). METHODS The diagnostic tumor and nodal volumes of 39 non-OPSCC patients were contoured and compared to corresponding RT planning scan volumes to determine TSGR. Overall survival (OS), disease-free survival (DFS), and local recurrence-free survival were evaluated according to the Kaplan-Meier method; and hazard ratios (HR) were estimated using Cox regression. Based on the 75th percentile TSGR of 2.18%, we stratified patients into a high TSGR group (≥ 2.18% per day) and low TSGR group (< 2.18% per day). RESULTS The median follow-up was 22 months (range: 1-86 months) and median time between diagnostic and simulation computed tomography scans was 22 days (range: 7-170 days). Median RT dose was 70 Gy (range: 60-79.2 Gy). Based on the 75th percentile TSGR, OS at median follow-up was 50.0% for the high TSGR group compared to 92.5% for the low TSGR group (HR [95% confidence interval (CI)] = 2.12[1.16-11.42], P = 0.018). There was a trend toward worse DFS at median follow-up for the high versus low TSGR groups, at 55.6% and 82.3%, respectively (HR [95% CI] = 2.29[0.82-6.38], P = 0.103). CONCLUSION Our study contributes to growing literature on TSGR as a temporal biomarker in patients with non-OPSCC. Patients with high TSGR ≥2.18% per day have significantly worse OS compared to those with TSGR below this threshold. Efforts to address treatment initiation delays may benefit patients with particularly aggressive and rapidly growing tumors. LEVEL OF EVIDENCE 4 Laryngoscope, 130:2378-2384, 2020.
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Affiliation(s)
| | - Jie Jane Chen
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - M Mohsin Fareed
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | | | - Thomas M Churilla
- the Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, U.S.A
| | - Miriam N Lango
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, U.S.A
| | - Thomas J Galloway
- the Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, U.S.A
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28
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Vieira B, Demirtas D, B van de Kamer J, Hans EW, van Harten W. Improving workflow control in radiotherapy using discrete-event simulation. BMC Med Inform Decis Mak 2019; 19:199. [PMID: 31651304 PMCID: PMC6814107 DOI: 10.1186/s12911-019-0910-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 09/06/2019] [Indexed: 11/22/2022] Open
Abstract
Background In radiotherapy, minimizing the time between referral and start of treatment (waiting time) is important to possibly mitigate tumor growth and avoid psychological distress in cancer patients. Radiotherapy pre-treatment workflow is driven by the scheduling of the first irradiation session, which is usually set right after consultation (pull strategy) or can alternatively be set after the pre-treatment workflow has been completed (push strategy). The objective of this study is to assess the impact of using pull and push strategies and explore alternative interventions for improving timeliness in radiotherapy. Methods Discrete-event simulation is used to model the patient flow of a large radiotherapy department of a Dutch hospital. A staff survey, interviews with managers, and historical data from 2017 are used to generate model inputs, in which fluctuations in patient inflow and resource availability are considered. Results A hybrid (40% pull / 60% push) strategy representing the current practice (baseline case) leads to 12% lower average waiting times and 48% fewer first appointment rebooks when compared to a full pull strategy, which in turn leads to 41% fewer patients breaching the waiting time targets. An additional scenario analysis performed on the baseline case showed that spreading consultation slots evenly throughout the week can provide a 21% reduction in waiting times. Conclusions A 100% pull strategy allows for more patients starting treatment within the waiting time targets than a hybrid strategy, in spite of slightly longer waiting times and more first appointment rebooks. Our algorithm can be used by radiotherapy policy makers to identify the optimal balance between push and pull strategies to ensure timely treatments while providing patient-centered care adapted to their specific conditions.
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Affiliation(s)
- Bruno Vieira
- Department of Radiation Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands. .,Center for Healthcare Operations Improvement and Research (CHOIR), University of Twente, Enschede, The Netherlands.
| | - Derya Demirtas
- Center for Healthcare Operations Improvement and Research (CHOIR), University of Twente, Enschede, The Netherlands.,Department of Industrial Engineering and Business Information Systems, Faculty of Behavioural Management and Social Sciences, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Jeroen B van de Kamer
- Department of Radiation Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands
| | - Erwin W Hans
- Center for Healthcare Operations Improvement and Research (CHOIR), University of Twente, Enschede, The Netherlands.,Department of Industrial Engineering and Business Information Systems, Faculty of Behavioural Management and Social Sciences, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Wim van Harten
- Department of Radiation Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands.,Department of Health Technology and Services Research, School of Governance and Management, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands.,Rijnstate General Hospital, Arnhem, The Netherlands
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29
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Harris JP, Chen MM, Orosco RK, Sirjani D, Divi V, Hara W. Association of Survival With Shorter Time to Radiation Therapy After Surgery for US Patients With Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2019. [PMID: 29522072 DOI: 10.1001/jamaoto.2017.3406] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Importance Shortening the time from surgery to the start of radiation (TS-RT) is a consideration for physicians and patients. Although the National Comprehensive Cancer Network recommends radiation to start within 6 weeks, a survival benefit with this metric remains controversial. Objective To determine the association of delayed TS-RT with overall survival (OS) using a large cancer registry. Design, Setting, and Participants In this observational cohort study, 25 216 patients with nonmetastatic stages III to IV head and neck cancer were identified from the National Cancer Database (NCDB). Exposures Patients received definitive surgery followed by adjuvant radiation therapy, with an interval duration defined as TS-RT. Main Outcomes and Measures Overall survival as a function of TS-RT and the effect of clinicopathologic risk factors and accelerated fractionation. Results We identified 25 216 patients with nonmetastatic squamous cell carcinoma of the head and neck. There were 18 968 (75%) men and 6248 (25%) women and the mean (SD) age of the cohort was 59 (10.9) years. Of the 25 216 patients, 9765 (39%) had a 42-days or less TS-RT and 4735 (19%) had a 43- to 49-day TS-RT. Median OS was 10.5 years (95% CI, 10.0-11.1 years) for patients with a 42-days or less TS-RT, 8.2 years (95% CI, 7.4-8.6 years; absolute difference, -2.4 years, 95% CI, -1.5 to -3.2 years) for patients with a 43- to 49-day TS-RT, and 6.5 years (95% CI, 6.1-6.8 years; absolute difference, -4.1 years, 95% CI, -3.4 to -4.7 years) for those with a 50-days or more TS-RT. Multivariable analysis found that compared with a 42-days or less TS-RT, there was not a significant increase in mortality with a 43- to 49-day TS-RT (HR, 0.98; 95% CI, 0.93-1.04), although there was for a TS-RT of 50 days or more (HR, 1.07; 95% CI, 1.02-1.12). A significant interaction was identified between TS-RT and disease site. Subgroup effect modeling found that a delayed TS-RT of 7 days resulted in significantly worse OS for patients with tonsil tumors (HR, 1.22; 95% CI, 1.05-1.43) though not other tumor subtypes. Accelerated fractionation of 5.2 fractions or more per week was associated with improved survival (HR, 0.93; 95% CI, 0.87-0.99) compared with standard fractionation. Conclusions and Relevance Delayed TS-RT of 50 days or more was associated with worse overall survival. The multidisciplinary care team should focus on shortening TS-RT to improve survival. Unavoidable delays may be an indication for accelerated fractionation or other dose intensification strategies.
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Affiliation(s)
- Jeremy P Harris
- Department of Radiation Oncology, Stanford University, Stanford, California.,Palo Alto Veterans Affairs Health Care System, Palo Alto, California
| | - Michelle M Chen
- Palo Alto Veterans Affairs Health Care System, Palo Alto, California.,Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California
| | - Ryan K Orosco
- Department of Head and Neck Surgery, University of California San Diego, San Diego
| | - Davud Sirjani
- Palo Alto Veterans Affairs Health Care System, Palo Alto, California.,Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California
| | - Vasu Divi
- Palo Alto Veterans Affairs Health Care System, Palo Alto, California.,Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California
| | - Wendy Hara
- Department of Radiation Oncology, Stanford University, Stanford, California
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30
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Evaluating radiotherapy treatment delay using Failure Mode and Effects Analysis (FMEA). Radiother Oncol 2019; 137:102-109. [DOI: 10.1016/j.radonc.2019.04.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 04/13/2019] [Accepted: 04/15/2019] [Indexed: 11/22/2022]
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31
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The effect of time between diagnosis and initiation of treatment on outcomes in patients with head and neck squamous cell carcinoma. Oral Oncol 2019; 96:148-152. [PMID: 31422206 DOI: 10.1016/j.oraloncology.2019.07.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 07/10/2019] [Accepted: 07/24/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To quantify the effect that time to initiation of treatment after diagnosis has on the outcomes of patients with head and neck squamous cell carcinoma (HNSCC). METHODS This is a single institution retrospective analysis of 633 HNSCC patients treated from 2004 to 2017. Clinical information was abstracted from the medical records. Patients were divided into quartiles based on the time to treatment initiation (0-27 days, 28-41 days, 42-60 days, and >60 days). Kaplan-Meier overall survival (OS) curves and multivariate cox proportional hazard ratios were determined for time to treatment quartiles. RESULTS Differences in Kaplan-Meier estimates for OS based on treatment time quartiles were statistically significantly (p = 0.02), and multivariate Cox Proportional hazard ratios for OS revealed that patients in the 42-60 day treatment time group had better OS (hazard ratio = 0.55) compared to patients treated >days after diagnosis (p < 0.01). CONCLUSIONS For our study population, increased time to initiation of treatment did not impact overall survival. These results may help to alleviate patient anxiety while allowing time for useful interventions such as smoking cessation, nutritional counseling, and others that can affect clinical outcomes.
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Fareed MM, Galloway TJ. Time abides long enough for those who make use of it. CANCERS OF THE HEAD & NECK 2019; 3:11. [PMID: 31093364 PMCID: PMC6460542 DOI: 10.1186/s41199-018-0038-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 11/09/2018] [Indexed: 01/29/2023]
Abstract
Increased treatment package time is an independent poor prognostic factor for outcomes in head and neck squamous cell carcinoma (HNSCC). Similarly the timeliness of treatment initiation is a risk factor for disease recurrence. Despite these well-known issues, the timeliness of treatment initiation is actually worsening in the United States and the expeditious completion of radiation treatments continues to be difficult secondary to a number of patients and treatment related issues. This analysis evaluates the current data on treatment intervals in the management of head and neck cancer. Rapid staging/diagnosis of head and neck cancer, appropriate referrals to providers qualified to treat said cancer, and expeditious treatment completion remains the most cost-effective, widely applicable method to improve outcomes in head and neck cancer.
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Affiliation(s)
- Muhammad M Fareed
- Department of Radiation Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111 USA
| | - Thomas J Galloway
- Department of Radiation Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111 USA
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33
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Lee NCJ, Kelly JR, An Y, Park HS, Judson BL, Burtness BA, Husain ZA. Radiation therapy treatment facility and overall survival in the adjuvant setting for locally advanced head and neck squamous cell carcinoma. Cancer 2019; 125:2018-2026. [PMID: 30748002 DOI: 10.1002/cncr.32001] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/09/2019] [Accepted: 01/14/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Treatment at high-volume surgical facilities (HVSFs) provides a survival benefit for patients with head and neck squamous cell carcinomas (HNSCCs); however, it is unknown what role postoperative radiation therapy (PORT) plays in achieving the improved outcomes. METHODS From the National Cancer Database, 6844 patients with locally advanced invasive HNSCCs of the oral cavity, oropharynx, larynx, and hypopharynx who underwent definitive surgery with PORT between 2004 and 2013 were identified. HVSFs were those in the top percentile for annual case volume during this period. RESULTS The median follow-up was 54 months. Compared with a lower volume surgical facility (LVSF), an HVSF improved 5-year overall survival (OS; 57.7% at HVSFs vs 52.5% at LVSFs; P = .0003). Overall, 31.6% of the patients changed their radiation therapy (RT) facility after surgery, with this being more common at HVSFs (39.1% vs 28.9% at LVSFs; P < .001). Among those patients undergoing surgery at an HVSF, remaining at the same facility for RT improved 5-year OS (63.1% vs 49.3% with a facility change; P < .0001). A propensity score-matched cohort of patients treated at HVSFs confirmed the improved 5-year OS when patients remained at the treating HVSF for RT (59.2% vs 50.7% with a facility change; P = .005). In a multivariate analysis, treatment at an HVSF and remaining there for RT resulted in a reduced hazard of death (hazard ratio, 0.81; 95% confidence interval, 0.69-0.94; P = .006). CONCLUSIONS The survival benefit associated with HVSFs persists only when patients remain at the facility for RT, and this suggests that facility specialization and/or high-volume PORT may assist in driving the OS improvement.
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Affiliation(s)
- Nicholas C J Lee
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Jacqueline R Kelly
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Yi An
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Henry S Park
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Benjamin L Judson
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Barbara A Burtness
- Division of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Zain A Husain
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut.,Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
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34
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Goel AN, Frangos M, Raghavan G, Sangar S, Lazaro S, Wang MB, Long JL, St. John MA. Survival impact of treatment delays in surgically managed oropharyngeal cancer and the role of human papillomavirus status. Head Neck 2019; 41:1756-1769. [DOI: 10.1002/hed.25643] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 10/13/2018] [Accepted: 12/10/2018] [Indexed: 01/03/2023] Open
Affiliation(s)
- Alexander N. Goel
- Department of Head and Neck SurgeryDavid Geffen School of Medicine at University of California Los Angeles Los Angeles California
| | - Mariana Frangos
- Department of Head and Neck SurgeryDavid Geffen School of Medicine at University of California Los Angeles Los Angeles California
| | - Govind Raghavan
- Department of Head and Neck SurgeryDavid Geffen School of Medicine at University of California Los Angeles Los Angeles California
| | - Sophia Sangar
- Department of Head and Neck SurgeryDavid Geffen School of Medicine at University of California Los Angeles Los Angeles California
| | - Stephanie Lazaro
- Department of Head and Neck SurgeryDavid Geffen School of Medicine at University of California Los Angeles Los Angeles California
| | - Marilene B. Wang
- Department of Head and Neck SurgeryDavid Geffen School of Medicine at University of California Los Angeles Los Angeles California
- Jonsson Comprehensive Cancer CenterUCLA Medical Center Los Angeles California
- UCLA Head and Neck Cancer ProgramUCLA Medical Center Los Angeles California
| | - Jennifer L. Long
- Department of Head and Neck SurgeryDavid Geffen School of Medicine at University of California Los Angeles Los Angeles California
- Research ServiceDepartment of Veterans Affairs Los Angeles California
| | - Maie A. St. John
- Department of Head and Neck SurgeryDavid Geffen School of Medicine at University of California Los Angeles Los Angeles California
- Jonsson Comprehensive Cancer CenterUCLA Medical Center Los Angeles California
- UCLA Head and Neck Cancer ProgramUCLA Medical Center Los Angeles California
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35
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Ramey SJ, Rich BJ, Kwon D, Mellon EA, Wolfson A, Portelance L, Yechieli R. Demographic disparities in delay of definitive chemoradiation for anal squamous cell carcinoma: a nationwide analysis. J Gastrointest Oncol 2018; 9:1109-1126. [PMID: 30603130 PMCID: PMC6286932 DOI: 10.21037/jgo.2018.08.07] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 07/23/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Prolonged time to treatment initiation (TTI) for patients with curable anal cancer may reduce tumor control. This study investigated demographic disparities in TTI for patients receiving definitive chemoradiation (CRT) for anal squamous cell carcinoma (A-SCC). METHODS Adult patients with A-SCC diagnosed from 2004 to 2014 and treated with definitive CRT were identified in the National Cancer Database (NCDB). TTI was defined as days from diagnosis to start of CRT. A negative binomial regression model estimated predicted TTI (pTTI) values. Cox proportional hazards model evaluated the impact of TTI on overall survival (OS). RESULTS Overall, 12,546 patients were included with 9% Non-Hispanic Black patients and 4% Hispanic patients. Multivariable analysis (MVA) showed that pTTI varied significantly by race/ethnicity with Non-Hispanic Black patients having a pTTI of 50 vs. 38 days for Non-Hispanic White patients [relative risk (RR), 1.21; 95% confidence interval (CI), 1.17-1.25]. For Hispanic patients, pTTI was 48 days, significantly longer than that of Non-Hispanic White patients (RR, 1.19; 95% CI, 1.14-1.24). Gender, insurance status, education level, urban category, distance to reporting facility, treatment facility type, intensity-modulated radiation therapy (IMRT)/proton use, T/N classification, and comorbidity status were all also associated with significant variation in TTI. TTI was not independently associated with changes in OS on MVA [hazard ratio (HR), 0.999; 95% CI, 0.997-1.002]. CONCLUSIONS Non-Hispanic Black and Hispanic patients have longer delays in starting definitive CRT for A-SCC. While TTI was not associated with OS, future analyses should explore the impact of TTI on local control, metastases, and patient-reported outcomes.
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Affiliation(s)
- Stephen J. Ramey
- Department of Radiation Oncology, Georgia Cancer Center, Augusta University, Augusta, Georgia, USA
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center/University of Miami Miller School of Medicine, Miami, USA
| | - Benjamin J. Rich
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center/University of Miami Miller School of Medicine, Miami, USA
| | - Deukwoo Kwon
- Biostatistics and Bioinformatics Core, Sylvester Comprehensive Cancer Center/University of Miami Miller School of Medicine, Miami, USA
| | - Eric A. Mellon
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center/University of Miami Miller School of Medicine, Miami, USA
| | - Aaron Wolfson
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center/University of Miami Miller School of Medicine, Miami, USA
| | - Lorraine Portelance
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center/University of Miami Miller School of Medicine, Miami, USA
| | - Raphael Yechieli
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center/University of Miami Miller School of Medicine, Miami, USA
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Radiologic-Pathologic Correlation of Extranodal Extension in Patients With Squamous Cell Carcinoma of the Oral Cavity: Implications for Future Editions of the TNM Classification. Int J Radiat Oncol Biol Phys 2018; 102:698-708. [DOI: 10.1016/j.ijrobp.2018.05.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 04/23/2018] [Accepted: 05/03/2018] [Indexed: 11/24/2022]
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37
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Morse E, Berson E, Fujiwara R, Judson B, Mehra S. Hypopharyngeal Cancer Treatment Delays: Benchmarks and Survival Association. Otolaryngol Head Neck Surg 2018; 160:267-276. [DOI: 10.1177/0194599818797605] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective To characterize treatment delays in hypopharyngeal cancer, identify factors associated with delays, and associate delays with overall survival. Study Design Retrospective cohort. Setting Commission on Cancer hospitals nationwide. Subjects and Methods We included patients in the National Cancer Database who were treated for hypopharyngeal cancer with primary radiation, concurrent chemoradiation, or induction chemotherapy and radiation. We identified median durations of diagnosis to treatment initiation (DTI), radiation treatment duration (RTD), and diagnosis to treatment end (DTE). We associated delays with patient, tumor, and treatment factors and overall survival via multivariable logistic and Cox proportional hazards regression, respectively. Results A total of 3850 patients treated with primary radiation or concurrent chemoradiation were included. Median durations of DTI, RTD, and DTE were 37, 52, and 92 days, respectively. Nonwhite race was associated with delays in DTI (odds ratio [OR] = 0.64; 95% CI, 0.51-0.80; P < .001) and DTE (OR = 0.60; 95% CI, 0.49-0.75; P < .001). Medicaid insurance was associated with delays in DTI (OR = 1.43; 95% CI, 1.07-1.90; P = .015), RTD (OR = 1.39; 95% CI, 1.06-1.83; P = .018), and DTE (OR = 1.48; 95% CI, 1.12-1.97; P = .007). Delays in RTD (hazard ratio [HR] = 1.24; 95% CI, 1.11-1.37; P < .001), not DTI (HR = 0.92; 95% CI, 0.82-1.03; P = .150) or DTE (HR = 1.01; 95% CI, 0.90-1.15; P = .825), were associated with impaired overall survival. We identified 922 patients who received induction chemotherapy. Delays in DTI, RTD, and DTE were not associated with overall survival in this cohort (HR = 1.10; 95% CI, 0.87-1.39; P = 0.435; HR = 1.05; 95% CI, 0.83-1.32; P = 0.686; HR = 1.11; 95% CI, 0.88-1.41; P = 0.377, respectively). Conclusions The median durations identified can serve as national benchmarks. Delays during radiation are associated with impaired overall survival among patients treated with primary radiation or chemoradiation but not patients treated with induction chemotherapy.
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Affiliation(s)
- Elliot Morse
- Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Elisa Berson
- Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Rance Fujiwara
- Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Benjamin Judson
- Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA
- Yale Cancer Center, New Haven, Connecticut, USA
| | - Saral Mehra
- Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA
- Yale Cancer Center, New Haven, Connecticut, USA
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Flores-Balcázar CH, Flores-Luna L, Villarreal-Garza C, Mota-García A, Bargalló-Rocha E. Impact of Delayed Adjuvant Radiotherapy in the Survival of Women with Breast Cancer. Cureus 2018; 10:e3071. [PMID: 30510860 PMCID: PMC6267615 DOI: 10.7759/cureus.3071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective Our objective was to determine whether a delay in adjuvant radiotherapy is related to a decrease in relapse-free survival and disease-specific survival of women with operable breast cancer. Methods Data on 1000 patients diagnosed with breast cancer were recorded. The cohort was divided into five groups according to the timing of radiotherapy: ≤30 days, 31 to 60 days, 61 to 90 days, 91 to 120 days, and >120 days. The relapse-free survival and disease-specific survival were also calculated in relation to the number of patients. Results This study found no statistical difference for delays in adjuvant radiotherapy in patients with early breast cancer, but we noted a statistical decrease in disease-specific survival in patients with locally advanced breast cancer receiving radiotherapy after a delay of at least 60 days. Conclusion Waiting times for radiotherapy should be as short as reasonably achievable, given the specific risk factors in the individual patient.
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Zhang WW, Wu SG, Sun JY, Li FY, He ZY. Long-term survival effect of the interval between mastectomy and radiotherapy in locally advanced breast cancer. Cancer Manag Res 2018; 10:2047-2054. [PMID: 30038520 PMCID: PMC6053260 DOI: 10.2147/cmar.s163863] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Introduction The timing of postmastectomy radiotherapy (PMRT) may influence locoregional recurrence and survival outcomes. In this study, we assessed the long-term survival effect of the interval between surgery and PMRT in locally advanced breast cancer treated with mastectomy and adjuvant chemotherapy. Methods In this retrospective study, we included women with locally advanced breast cancer who underwent adjuvant chemotherapy and PMRT after mastectomy between 1999 and 2007. Based on the interval between surgery and PMRT, the patients were classified into three groups: Group 1 (≤4 vs >4 months), Group 2 (≤5 vs >5 months), and Group 3 (≤6 vs >6 months). Univariate and multivariate regression analyses were performed to determine the prognostic factors of survival outcomes. Results A total of 340 women were included in this study, and the median follow-up duration was 79.8 months. The median surgery–PMRT interval was 5 months. The surgery–PMRT interval including Group 1, Group 2, and Group 3 was not significantly associated with locoregional recurrence-free survival, distant metastasis-free survival, disease-free survival, and overall survival. In addition, in the subgroup analysis of the effect of surgery–PMRT interval on survival outcomes according to various clinicopathologic factors, the surgery–PMRT interval was also not associated with survival outcomes in different age groups, tumor stage, and breast cancer subtypes. Conclusion Our findings suggest that the delay in the start of PMRT in locally advanced breast cancer does not increase the likelihood of locoregional recurrence, distant metastasis, and death.
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Affiliation(s)
- Wen-Wen Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, People's Republic of China,
| | - San-Gang Wu
- Department of Radiation Oncology, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen 361003, People's Republic of China
| | - Jia-Yuan Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, People's Republic of China,
| | - Feng-Yan Li
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, People's Republic of China,
| | - Zhen-Yu He
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, People's Republic of China,
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40
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Morse E, Judson B, Husain Z, Burtness B, Yarbrough W, Sasaki C, Cheraghlou S, Mehra S. National treatment times in oropharyngeal cancer treated with primary radiation or chemoradiation. Oral Oncol 2018; 82:122-130. [DOI: 10.1016/j.oraloncology.2018.02.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/24/2018] [Accepted: 02/11/2018] [Indexed: 10/16/2022]
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Rosenblatt E, Fidarova E, Zubizarreta EH, Barton MB, Jones GW, Mackillop WJ, Cordero L, Yarney J, Lim G, Gan JV, Cernea V, Stojanovic-Rundic S, Strojan P, Kochbati L, Quarneti A. Radiotherapy utilization in developing countries: An IAEA study. Radiother Oncol 2018; 128:400-405. [PMID: 29859755 DOI: 10.1016/j.radonc.2018.05.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 05/09/2018] [Accepted: 05/15/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND The planning of national radiotherapy (RT) services requires a thorough knowledge of the country's cancer epidemiology profile, the radiotherapy utilization (RTU) rates and a future projection of these data. Previous studies have established RTU rates in high-income countries. METHODS Optimal RTU (oRTU) rates were determined for nine middle-income countries, following the epidemiological evidence-based method. The actual RTU (aRTU) rates were calculated dividing the total number of new notifiable cancer patients treated with radiotherapy in 2012 by the total number of cancer patients diagnosed in the same year in each country. An analysis of the characteristics of patients and treatments in a series of 300 consecutive radiotherapy patients shed light on the particular patient and treatments profile in the participating countries. RESULTS The median oRTU rate for the group of nine countries was 52% (47-56%). The median aRTU rate for the nine countries was 28% (9-46%). These results show that the real proportion of cancer patients receiving RT is lower than the optimal RTU with a rate difference between 10-42.7%. The median percent-unmet need was 47% (18-82.3%). CONCLUSIONS The optimal RTU rate in middle-income countries did not differ significantly from that previously found in high-income countries. The actual RTU rates were consistently lower than the optimal, in particular in countries with limited resources and a large population.
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Affiliation(s)
| | | | | | - Michael B Barton
- Ingham Institute for Applied Medical Research, UNSW, Sydney, Australia
| | - Glenn W Jones
- The Cancer Centre Eastern Caribbean, St. John's, Antigua and Barbuda
| | | | | | - Joel Yarney
- Centre for Radiotherapy and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | - Gerard Lim
- National Cancer Institute, Putrajaya, Malaysia
| | - John V Gan
- Jose R. Reyes Memorial Medical Centre, Quezon City, Philippines
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Morse E, Fujiwara RJ, Judson B, Mehra S. Treatment delays in laryngeal squamous cell carcinoma: A national cancer database analysis. Laryngoscope 2018; 128:2751-2758. [DOI: 10.1002/lary.27247] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/13/2018] [Accepted: 03/29/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Elliot Morse
- Department of Surgery, Division of Otolaryngology; Yale University School of Medicine; New Haven Connecticut U.S.A
| | - Rance J.T. Fujiwara
- Department of Surgery, Division of Otolaryngology; Yale University School of Medicine; New Haven Connecticut U.S.A
| | - Benjamin Judson
- Department of Surgery, Division of Otolaryngology; Yale University School of Medicine; New Haven Connecticut U.S.A
| | - Saral Mehra
- Department of Surgery, Division of Otolaryngology; Yale University School of Medicine; New Haven Connecticut U.S.A
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Rosenblatt E, Fidarova E, Ghosh S, Zubizarreta E, Unterkirhere O, Semikoz N, Sinaika V, Kim V, Karamyan N, Isayev I, Akbarov K, Lomidze D, Bondareva O, Tuzlucov P, Zardodkhonova M, Tkachev S, Kislyakova M, Alimov J, Pidlubna T, Barton M, Mackillop W. Quality of radiotherapy services in post-Soviet countries: An IAEA survey. Radiother Oncol 2018; 127:171-177. [PMID: 29705501 DOI: 10.1016/j.radonc.2018.03.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/18/2018] [Accepted: 03/28/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND The quality of radiotherapy services in post-Soviet countries has not yet been studied following a formal methodology. The IAEA conducted a survey using two sets of validated radiation oncology quality indicators (ROIs). METHODS Eleven post-Soviet countries were assessed. A coordinator was designated for each country and acted as the liaison between the country and the IAEA. The methodology was a one-time cross-sectional survey using a 58-question tool in Russian. The questionnaire was based on two validated sets of ROIs: for radiotherapy centres, the indicators proposed by Cionini et al., and for data at the country level, the Australasian ROIs. RESULTS The overall response ratio was 66.3%, but for the Russian Federation, it was 24%. Data were updated on radiotherapy infrastructure and equipment. 256 radiotherapy centres are operating 275 linear accelerators and 337 Cobalt-60 units. 61% of teletherapy machines are older than ten years. Analysis of ROIs revealed significant differences between these countries and radiotherapy practices in the West. Naming, task profile and education programmes of radiotherapy professionals are different than in the West. CONCLUSIONS Most countries need modernization of their radiotherapy infrastructure coupled with adequate staffing numbers and updated education programmes focusing on evidence-based medicine, quality, and safety.
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Affiliation(s)
- Eduardo Rosenblatt
- Div. of Human Health, International Atomic Energy Agency, Vienna, Austria.
| | - Elena Fidarova
- Div. of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Sunita Ghosh
- Cancer Biostatistics, Univ. of Alberta, Edmonton, Canada
| | | | - Olga Unterkirhere
- Div. of Human Health, International Atomic Energy Agency, Vienna, Austria
| | | | - Valery Sinaika
- N.N. Alexandrov National Cancer Center of Belarus, Minsk, Belarus
| | - Viktor Kim
- Kazakhstan Research Institute of Oncology and Radiology, Almaty, Kazakhstan
| | | | - Isa Isayev
- National Center of Oncology, Baku, Azerbaijan
| | | | - Darejan Lomidze
- Tbilisi State Medical University, HTMC, University Clinic, Tbilisi, Georgia
| | | | | | | | - Sergey Tkachev
- N.N. Blokhin National Medical Research Center of Oncology, Russian Federation
| | | | - Jamshid Alimov
- National Research Center of Oncology, Tashkent, Uzbekistan
| | | | - Michael Barton
- Ingham Institute for Applied Medical Research, UNSW, Sydney, Australia
| | - William Mackillop
- Queen's University, Division of Cancer Care & Epidemiology, Kingston, Ontario, Canada
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McLaughlin PY, Kong W, de Metz C, Hanna TP, Brundage M, Warde P, Gutierrez E, Mackillop WJ. Do radiation oncology outreach clinics affect the use of radiotherapy? Radiother Oncol 2018; 127:143-149. [DOI: 10.1016/j.radonc.2017.11.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/16/2017] [Accepted: 11/16/2017] [Indexed: 10/17/2022]
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45
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Fareed MM, Ishtiaq R, Galloway TJ. Testing the Timing: Time Factor in Radiation Treatment for Head and Neck Cancers. Curr Treat Options Oncol 2018. [PMID: 29527638 DOI: 10.1007/s11864-018-0534-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OPINION STATEMENT Overall radiation treatment time has long been recognized as an important factor in head and neck tumor control. The concern of tumor growth in waiting time either before starting radiotherapy or during treatment is substantial given its negative impact on clinical outcome. There is an overwhelming evidence that increasing the time to initiate treatment increases the tumor burden and worsens the prognosis. This effect is more pronounced especially in patients with an early stage cancer disease. Delay in treatment initiation is contributed by both health care- and patient-related factors. Health care-related factors include advancement in diagnostic modalities and transfer of patient to academic health care centers accompanied by delayed referrals and long-awaited appointments. Patient-related factors include delayed reporting time and socioeconomic factors. An efficient transition of care along with access of cancer care modalities to community health care centers will not only improve the quality of care in secondary health care centers but also help decrease the patient burden in tertiary centers. A quick and well-structured multidisciplinary appointment program is fundamental in shortening the time required for patient referrals, thus increasing the optimal survival time for Head and Neck cancer patients with early initiation of treatment.
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Affiliation(s)
- Muhammad M Fareed
- Department of Radiation Oncology, Dana-Farber/Brigham & Women's Cancer Center, Harvard Medical School, Boston, MA, 02115, USA.
| | - Rizwan Ishtiaq
- Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Boston, MA, 02120, USA
| | - Thomas J Galloway
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, 19111, USA
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Morse E, Fujiwara RJT, Judson B, Mehra S. Treatment Times in Salivary Gland Cancer: National Patterns and Association with Survival. Otolaryngol Head Neck Surg 2018; 159:283-292. [PMID: 29460669 DOI: 10.1177/0194599818758020] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Objective To characterize treatment times in salivary cancer; associate treatment times with patient, tumor, and treatment characteristics; and examine the association of treatment times and overall survival. Study Design Retrospective cohort. Setting Commission-on-Cancer Accredited Hospitals 2004-2013. Subjects and Methods In total, 5953 patients with salivary cancer included in the National Cancer Database were identified. For each treatment interval, patients in the fourth quartile ("prolonged") were compared to patients in the first and second quartiles ("not prolonged"). Patient, tumor, and treatment characteristics were associated with prolonged times via multivariable binary logistic regression. Prolongation of each interval was associated with overall survival via multivariable Cox proportional hazards regression, controlling for clinically relevant factors. Results Median durations for diagnosis-to-treatment initiation, surgery-to-radiation treatment (RT), RT duration, total treatment package, and diagnosis-to-treatment end were 31, 44, 47, 92, and 110 days, respectively. Race, insurance status, comorbidities, age, T and N stage, facility volume and location, and a facility care transition from diagnosis to initial treatment were associated with prolonged treatment time. Prolonged RT duration was associated with decreased overall survival (OS) (62% vs 75% 5-year OS, HR = 1.26 [95% confidence interval (CI), 1.09-1.47]; P = .002), but prolonged diagnosis-to-treatment initiation, surgery-to-RT, total treatment package, and diagnosis-to-treatment end intervals were not (70% vs 67% 5-year OS, HR = 1.11 [95% CI, 0.92-1.34], P = .284; 72% vs 68%, HR = 0.93 [95% CI, 0.79-1.09], P = .370; 70% vs 70%, HR = 1.00 [95% CI, 0.84-1.20], P = .974; 66% vs 71%, HR = 0.99 [95% CI, 0.84-1.18], P = .920, respectively). Conclusion The median durations identified here can serve as reference points. Radiation therapy duration is associated with overall survival in salivary cancer and could be considered a quality indicator.
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Affiliation(s)
- Elliot Morse
- 1 Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Rance J T Fujiwara
- 1 Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Benjamin Judson
- 1 Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Saral Mehra
- 1 Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA
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Coca-Pelaz A, Takes RP, Hutcheson K, Saba NF, Haigentz M, Bradford CR, de Bree R, Strojan P, Lund VJ, Mendenhall WM, Nixon IJ, Quer M, Rinaldo A, Ferlito A. Head and Neck Cancer: A Review of the Impact of Treatment Delay on Outcome. Adv Ther 2018; 35:153-160. [PMID: 29396681 DOI: 10.1007/s12325-018-0663-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Indexed: 12/29/2022]
Abstract
Delay between the initial symptoms, diagnosis, and the definitive treatment of head and neck cancers is associated with tumor progression and upstaging. These delays may lead to poor outcomes and may mandate more aggressive treatments with unnecessary morbidity and even mortality. The multidisciplinary team approach for the treatment of patients with head and neck cancers has improved organization of standard clinical guidelines, but this development has yet to translate into a demonstrable impact on survival. We review the association between waiting times (time between diagnosis and initiation of treatment) and clinical outcomes in patients with head and neck squamous cell carcinoma (HNSCC).
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Affiliation(s)
- Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kate Hutcheson
- Department of Head and Neck Surgery, Section of Speech Pathology and Audiology, MD Anderson Cancer Center, Houston, TX, USA
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, The Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Missak Haigentz
- Division of Hematology/Oncology, Department of Medicine, Morristown Medical Center/Atlantic Health System, Morristown, NJ, USA
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Valerie J Lund
- Professorial Unit, Ear Institute, University College London, London, UK
| | | | - Iain J Nixon
- Department of Surgery and Otolaryngology, Head and Neck Surgery, Edinburgh University, Edinburgh, UK
| | - Miquel Quer
- Department of Otolaryngology, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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Rastogi K, Gupta S, Bhatnagar A, Singh D, Gupta K, Choudhary A. Compliance to radiotherapy: A tertiary care center experience. Indian J Cancer 2018; 55:166-169. [DOI: 10.4103/ijc.ijc_517_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Silva SB, Pereira AAL, Marta GN, de Barros Lima KML, de Freitas TB, Matutino ARB, de Azevedo Souza MCL, de Azevedo RGMV, de Viveiros PAH, da Silva Lima JM, Filassi JR, de Andrade Carvalho H, Piato JRM, Mano MS. Clinical impact of adjuvant radiation therapy delay after neoadjuvant chemotherapy in locally advanced breast cancer. Breast 2017; 38:39-44. [PMID: 29223797 DOI: 10.1016/j.breast.2017.11.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 11/05/2017] [Accepted: 11/10/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND and Purpose: Post-operative radiation therapy (PORT) is usually indicated for patients with breast cancer (BC) after neoadjuvant chemotherapy (NAC) and surgery. However, the optimal timing to initiation of PORT is currently unknown. MATERIAL AND METHODS We retrospectively evaluated data from patients with BC who received PORT after NAC and surgery at our institution from 2008 to 2014. Patients were categorized into three groups according to the time between surgery and PORT: <8 weeks, 8-16 weeks and >16 weeks. RESULTS A total of 581 patients were included; 74% had clinical stage III. Forty-three patients started PORT within 8 weeks, 354 between 8 and 16 weeks and 184 beyond 16 weeks from surgery. With a median follow-up of 32 months, initiation of PORT up to 8 weeks after surgery was associated with better disease-free survival (DFS) (<8 weeks versus 8-16 weeks: HR 0.33; 95% CI 0.13-0.81; p = 0.02; <8 weeks versus >16 weeks: HR 0.38; 95% CI 0.15-0.96; p = 0.04) and better overall survival (OS) (<8 weeks versus 8-16 weeks: HR 0.22; 95% CI 0.05-0.90; p = 0.036; <8 weeks versus >16 weeks: HR 0.28; 95% CI 0.07-1.15; p = 0.08). CONCLUSION PORT started up to 8 weeks after surgery was associated with better DFS and OS in locally-advanced BC patients submitted to NAC. Our findings suggest that early initiation of PORT is critically important for these patients. However, the low numbers of patients and events in this study prevent us from drawing firm conclusions.
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Affiliation(s)
- Saulo Brito Silva
- Department of Radiology and Oncology, Instituto do Cancer do Estado de São Paulo (ICESP), Universidade de São Paulo, São Paulo, Brazil
| | - Allan Andresson Lima Pereira
- Department of Radiology and Oncology, Instituto do Cancer do Estado de São Paulo (ICESP), Universidade de São Paulo, São Paulo, Brazil
| | - Gustavo Nader Marta
- Department of Radiology and Oncology, Instituto do Cancer do Estado de São Paulo (ICESP), Universidade de São Paulo, São Paulo, Brazil; Department of Radiation Oncology, Hospital Sírio-Libânes, São Paulo, Brazil.
| | | | - Thiago Brasileiro de Freitas
- Department of Radiology and Oncology, Instituto do Cancer do Estado de São Paulo (ICESP), Universidade de São Paulo, São Paulo, Brazil
| | - Adriana Reis Brandão Matutino
- Department of Radiology and Oncology, Instituto do Cancer do Estado de São Paulo (ICESP), Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Pedro Antonio Hermida de Viveiros
- Department of Radiology and Oncology, Instituto do Cancer do Estado de São Paulo (ICESP), Universidade de São Paulo, São Paulo, Brazil
| | - Julianne Maria da Silva Lima
- Department of Radiology and Oncology, Instituto do Cancer do Estado de São Paulo (ICESP), Universidade de São Paulo, São Paulo, Brazil
| | - José Roberto Filassi
- Department of Gynecology and Obstetrics, Breast Surgery Unit, Universidade de São Paulo, Brazil
| | - Heloísa de Andrade Carvalho
- Department of Radiology and Oncology, Instituto do Cancer do Estado de São Paulo (ICESP), Universidade de São Paulo, São Paulo, Brazil
| | | | - Max S Mano
- Department of Radiology and Oncology, Instituto do Cancer do Estado de São Paulo (ICESP), Universidade de São Paulo, São Paulo, Brazil; Division of Medical Oncology, Hospital Sírio-Libanês, São Paulo, Brazil
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Simons P, Backes H, Bergs J, Emans D, Johannesma M, Jacobs M, Marneffe W, Vandijck D. The effects of a lean transition on process times, patients and employees. Int J Health Care Qual Assur 2017; 30:103-118. [PMID: 28256930 DOI: 10.1108/ijhcqa-08-2015-0106] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Treatment delays must be avoided, especially in oncology, to assure sustainable high-quality health care and increase the odds of survival. The purpose of this paper is to hypothesize that waiting times would decrease and patients and employees would benefit, when specific lean interventions are incorporated in an organizational improvement approach. Design/methodology/approach In 2013, 15 lean interventions were initiated to improve flow in a single radiotherapy institute. Process/waiting times, patient satisfaction, safety, employee satisfaction, and absenteeism were evaluated using a mixed methods methodology (2010-2014). Data from databases, surveys, and interviews were analyzed by time series analysis, χ2, multi-level regression, and t-tests. Findings Median waiting/process times improved from 20.2 days in 2012 to 16.3 days in 2014 ( p<0.001). The percentage of palliative patients for which waiting times had exceeded Dutch national norms (ten days) improved from 35 (six months in 2012: pre-intervention) to 16 percent (six months in 2013-2014: post-intervention; p<0.01), and the percentage exceeding national objectives (seven days) from 22 to 17 percent ( p=0.44). For curative patients, exceeding of norms (28 days) improved from 17 (2012) to 8 percent (2013-2014: p=0.05), and for the objectives (21 days) from 18 to 10 percent ( p<0.01). Reported safety incidents decreased 47 percent from 2009 to 2014, whereas safety culture, awareness, and intention to solve problems improved. Employee satisfaction improved slightly, and absenteeism decreased from 4.6 (2010) to 2.7 percent (2014; p<0.001). Originality/value Combining specific lean interventions with an organizational improvement approach improved waiting times, patient safety, employee satisfaction, and absenteeism on the short term. Continuing evaluation of effects should study the improvements sustainability.
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Affiliation(s)
- Pascale Simons
- Department of Radiation Oncology (MAASTRO), Faculty of Health, Medicine and Life Sciences, Maastricht University , Maastricht, The Netherlands
| | - Huub Backes
- Department of Radiation Oncology (MAASTRO), Maastricht, The Netherlands
| | - Jochen Bergs
- Faculty of Business Economics, Hasselt University , Hasselt, Belgium
| | - Davy Emans
- Department of Radiation Oncology (MAASTRO), Maastricht, The Netherlands
| | | | - Maria Jacobs
- Department of Radiation Oncology (MAASTRO), School for Public Health and Primary Care-Health Services Research, Maastricht University Medical Centre (MUMC+) , Maastricht, The Netherlands
| | - Wim Marneffe
- Faculty of Business Economics, Hasselt University , Hasselt, Belgium
| | - Dominique Vandijck
- Faculty of Health Sciences, Hasselt University , Hasselt, Belgium.,Faculty of Medicine and Health Sciences, Ghent University , Ghent, Belgium
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