Interruptions of Head and Neck Radiotherapy Across Insured and Indigent Patient Populations

Purpose: Radiotherapy for head and neck cancer is a cornerstone of care, requiring 30 to 35 days of treatment over 6 to 7 weeks. Diligent patient compliance is crucial, and unplanned treatment interruptions reduce cure rates. We studied interruption rates in private carrier–insured and Medicare-insured populations versus indigent populations served by a single academic health system. Materials and Methods: A retrospective cohort study of electronic medical and billing records was performed analyzing treatment interruptions between January 2011 and December 2014. The study included 564 patients with head and neck cancer prescribed radiotherapy and referred from clinics run by University of Texas Southwestern Medical Center (UTSW) and the Parkland Health and Hospital System (PHHS), which provides indigent care to Dallas County, Texas. Results: Three-hundred sixteen patients (56%) had a treatment break; 114 patients missed a single session, and 202 patients missed multiple treatments. Seventy percent of PHHS patients had treatment delays compared with 47% of UTSW patients ( P < .001). The number of interrupted days in the PHHS population was nearly twice that observed in UTSW patients. PHHS patients most commonly missed treatment for nonmedical or logistical reasons. Delay was predictive for local recurrence ( P < .001) and overall survival ( P < .001). In compliant patients, there was no significant difference in local recurrence ( P = .43) or overall survival ( P = .27) across referral sites. However, among noncompliant patients, there was a higher likelihood for local recurrence in the PHHS cohort ( P = .016). Multivariable modeling suggested treatment interruption to be a key driver of outcome differences across referral sites. Conclusion: Survival outcomes in our at-risk population were inferior to those in patients insured by commercial carriers or Medicare. Treatment interruption predicted for poor outcome across all patients but was disproportionately experienced by at-risk patients. These results highlight cancer control needs specific to disadvantaged communities at risk for poor treatment compliance.

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Which role plays specialized palliative care in patients with relapsed and/or metastatic head and neck cancer? A retrospective analysis in Southern Switzerland.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e17503 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e17503-e17503

Author(s):

Vittoria G. Espeli ◽

Claudia Gamondi ◽

Tanja Fusi-Schmidhauser

Keyword(s):

Palliative Care ◽

Overall Survival ◽

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Unknown Primary ◽

Early Palliative Care ◽

Significant Difference ◽

Specialized Palliative Care ◽

The Impact

e17503 Background: early palliative care (PC) for patients with advanced cancer improves quality of life, promotes home deaths and can improve survival. Limited data are available regarding PC in advanced head and neck cancer (HNC) patients. To investigate the effect of introducing specialized PC in patients with relapsed and/or metastatic head and neck cancer. Methods: between October 2010 and December 2018, the medical charts of all patients treated in the Oncology Institute of Southern Switzerland with relapsed and/or metastatic HNC were reviewed. Site, status of disease (metastatic at diagnosis, locally or metastatic relapsed), type and lines of treatment, treatment response and referral to specialist palliative care (yes or no) were documented. Comparisons were made between patients referred and non-referred to PC. Results: sixty-two patients with relapsed/metastatic HNC were identified, 32 (51.6%) of which were referred to specialized PC. Patients were mainly men (47, 75.8%), with a median age of 66 years (range 43 – 86). Forty-two patients (67.7%) had a metastatic disease and the most common site of tumor was the oropharynx (35.5%), followed by oral cavity (32.3%), larynx (16.1%), hypopharynx (12.9%), and unknown primary (3.2%). Forty-eight patients (77.4%) were treated with systemic treatment (75% in the PC group and 80% in the non-PC group, p = 0.638). The median overall survival was 8.1 months for all patients, 8 months for the PC group and 8.7 months for the non-PC group, without significant difference (p = 0.440). Of the deceased patients, 70% of the PC group and 73.3% of the non-PC group received chemotherapy in the last three months of life. A greater percentage of patients in the PC group died at home, but without significant difference (39.2% vs. 19%, p = 0.134). Conclusions: only half of the patient had access to specialized PC. Whereas it did not seem to affect overall survival nor influence chemotherapy prescription, it seemed to favor home deaths. Further studies investigating the impact of early PC in recurrent and/or metastatic HNC are needed to improve access to PC and maximize benefits.

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Assessment of cough in head and neck cancer patients at risk for dysphagia—An overview

Cancer Reports ◽

10.1002/cnr2.1395 ◽

2021 ◽

Author(s):

Sofiana Mootassim‐Billah ◽

Gwen Van Nuffelen ◽

Jean Schoentgen ◽

Marc De Bodt ◽

Tatiana Dragan ◽

...

Keyword(s):

At Risk ◽

Head And Neck Cancer ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Patients At Risk

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Which is the most suitable lymph node predictor for overall survival after primary surgery of head and neck cancer: pN, the number or the ratio of positive lymph nodes, or log odds?

Journal of Cancer Research and Clinical Oncology ◽

10.1007/s00432-015-2104-1 ◽

2015 ◽

Vol 142 (4) ◽

pp. 885-893 ◽

Cited By ~ 18

Author(s):

Mehmet Metin Yildiz ◽

Iver Petersen ◽

Ekkehard Eigendorff ◽

Peter Schlattmann ◽

Orlando Guntinas-Lichius

Keyword(s):

Overall Survival ◽

Head And Neck Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Head And Neck ◽

Neck Cancer ◽

Primary Surgery ◽

Log Odds ◽

Positive Lymph Nodes

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Bioelectrical impedance phase angle as a prognostic indicator of survival in head-and-neck cancer

Current Oncology ◽

10.3747/co.23.3181 ◽

2016 ◽

Vol 23 (5) ◽

pp. 481 ◽

Cited By ~ 14

Author(s):

M.S. Wladysiuk ◽

R. Mlak ◽

K. Morshed ◽

W. Surtel ◽

A. Brzozowska ◽

...

Keyword(s):

Overall Survival ◽

Head And Neck Cancer ◽

Head And Neck ◽

Phase Angle ◽

Neck Cancer ◽

Bioelectrical Impedance ◽

Impedance Analysis ◽

Neck Surgery ◽

Department Head ◽

Nutrition Status

Background Phase angle could be an alternative to subjective global assessment for the assessment of nutrition status in patients with head-and-neck cancer.Methods We prospectively evaluated a cohort of 75 stage iiib and iv head-and-neck patients treated at the Otolaryngology Department, Head and Neck Surgery, Medical University of Lublin, Poland. Bioelectrical impedance analysis was performed in all patients using an analyzer that operated at 50 kHz. The phase angle was calculated as reactance divided by resistance (Xc/R) and expressed in degrees. The Kaplan–Meier method was used to calculate survival.Results Median overall survival in the cohort was 32.0 months. At the time of analysis, 47 deaths had been recorded in the cohort (62.7%). The risk of shortened overall survival was significantly higher in patients whose phase angle was less than 4.733 degrees than in the remaining patients (19.6 months vs. 45 months, p = 0.0489; chi-square: 3.88; hazard ratio: 1.8856; 95% confidence interval: 1.0031 to 3.5446).Conclusions Phase angle might be prognostic of survival in patients with advanced head-and-neck cancer. Further investigation in a larger population is required to confirm our results.

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Investigation of relationship between change in locoregional control and change in overall survival in randomized controlled trials of modified radiotherapy in head-and-neck cancer

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2004.05.049 ◽

2004 ◽

Vol 60 (5) ◽

pp. 1405-1409 ◽

Cited By ~ 27

Author(s):

Jonathan C. Wadsley ◽

Søren M. Bentzen

Keyword(s):

Overall Survival ◽

Head And Neck Cancer ◽

Randomized Controlled Trials ◽

Head And Neck ◽

Neck Cancer ◽

Locoregional Control ◽

Controlled Trials ◽

Randomized Controlled

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Evaluation of the prevalence and severity of xerophthalmia in head and neck cancers patients undergoing curative radiotherapy

Asian Journal of Ophthalmology ◽

10.35119/asjoo.v14i4.149 ◽

2016 ◽

Vol 14 (4) ◽

Author(s):

Sowmya V ◽

Dipika Jayachander ◽

Vijna Kamath ◽

Mithun SK Rao ◽

Mohammed Raees Tonse ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Keratoconjunctivitis Sicca ◽

Study Objective ◽

Cancer Group ◽

Curative Radiotherapy ◽

Significant Difference ◽

Rectal Cancers

Background: The study objective was to assess the development of xerophthalmia [dry eye syndrome (DES) or keratoconjunctivitis sicca] in head and neck cancer patients undergoing radiotherapy.Methods: Twenty two head and neck cancer patients requiring more than 60 Gy of curative radiotherapy/chemoradiotherapy and ten patients requiring radiotherapy/ chemoradiotherapy for treating cancers in the non head and neck regions (like breast, oesophagus, prostate, cervix and rectal cancers) were also enrolled in the study. The development of DES was studied at the beginning (day 0, before the start of radiotherapy) at day 21 (after completion of 30 Gy) and on completion of the treatment (> 60 Gy). As a comparative cohort, people with non head and neck cancer needing curative radiotherapy were also evaluated for comparison.Results: There was no difference in degree of DES between the Head and Neck cancer cohorts and non head and neck group at the beginning of treatment. However there was a statistically significant difference (p < 0.001) between the two groups at both mid and end of RT time point. Inter comparison between the various time points in the head and neck cancer group showed that the incidence of DES increased with the radiation exposure and was significant (pre to mid p < 0.001; and mid to end p < 0.005). A negative (r = -0.262) correlation was seen between DES and distance.Conclusions: The study showed that lesser the distance from the epicenter of the radiation to the orbital rim more was the severity of DES.

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Comparison Between VMAT and IMRT in Remaining Volume at Risk for Large Volume Head and Neck Cancer Patients

Novel Approaches in Cancer Study ◽

10.31031/nacs.2021.06.000626 ◽

2021 ◽

Author(s):

Doaa Raafat Ali

Keyword(s):

At Risk ◽

Head And Neck Cancer ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Large Volume

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Importance of Treatment Institution in Head and Neck Cancer Radiotherapy

Otolaryngology ◽

10.1016/j.otohns.2009.03.019 ◽

2009 ◽

Vol 141 (2) ◽

pp. 172-176 ◽

Cited By ~ 12

Author(s):

Gregory J. Kubicek ◽

Fen Wang ◽

Eashwar Reddy ◽

Yelizaveta Shnayder ◽

Cristina E. Cabrera ◽

...

Keyword(s):

Head And Neck Cancer ◽

Treatment Outcome ◽

Head And Neck ◽

Neck Cancer ◽

Time Course ◽

Medical Center ◽

Recurrence Rates ◽

Historical Cohort ◽

Initial Surgery ◽

Significant Difference

OBJECTIVE: The treatment for head and neck cancer (HNC) often involves radiotherapy. Many HNC patients are treated at the academic center (AC) where the initial surgery or diagnosis was made. Because of the lengthy time course for radiotherapy, some patients are treated at community radiation facilities (non-AC) rather than the AC despite potential AC advantages in terms of experience and technology. Our goal is to determine if these potential AC advantages correspond to a difference in treatment outcome. STUDY DESIGN: Historical cohort study. SETTING: University of Kansas Medical Center, Kansas City, Kansas. SUBJECTS AND METHODS: Review of records of patients with HNC cancers evaluated at the otolaryngology (ENT) department of an AC. Each patient's information and treatment characteristics were recorded, including radiotherapy treatment venue and treatment outcome. RESULTS: Three hundred seventy-four patients were analyzed, 263 were treated at an AC and 101 at a non-AC. Patients treated at a non-AC were more likely to present with earlier stage tumors, be treated with radiation alone rather than chemoradiotherapy, and be treated with adjuvant rather than primary radiotherapy. There was no difference in overall survival or recurrence rates between AC and non-AC. CONCLUSION: Patients treated at an AC are more likely to have advanced stage tumors and receive chemoradiotherapy as their primary treatment. In analyses of matching patient subsets, there was no significant difference in patient outcomes. Patients can be treated at a non-AC without affecting outcome compared with treatment at an AC.

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