ArticleJournal of clinical oncology : official journal of the American Society of Clinical Oncology2016
Survival Impact of Increasing Time to Treatment Initiation for Patients With Head and Neck Cancer in the United States.
Article in Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 178 papers, 5 of them syntheses that pooled it.
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Who cites it
178 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- Treatment package time (TPT) and surgery to post-operative radiotherapy (S-PORT) interval in head and neck cancers: A systematic review and meta-analysis.European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery · 2025Pooled it
- Prelaminated flaps in head and neck cancer reconstructive surgery: A systematic review.Microsurgery · 2021Pooled it
- Mortality due to cancer treatment delay: systematic review and meta-analysis.BMJ (Clinical research ed.) · 2020Pooled it
- Nonsurgical management of resectable oral cavity cancer in the wake of COVID-19: A rapid review and meta-analysis.Oral oncology · 2020Pooled it
- Association of Treatment Delays With Survival for Patients With Head and Neck Cancer: A Systematic Review.JAMA otolaryngology-- head & neck surgery · 2019Pooled it
- Neoadjuvant leukocyte interleukin injection immunotherapy improves overall survival in low-risk locally advanced head and neck squamous cell carcinoma -thePathology oncology research : POR · 2025Trial
- Spray skin protectant versus standard moisturiser in the prevention of radiodermatitis in patients with anal canal and rectal cancer: A randomised clinical trial.International wound journal · 2024Trial
- Prognostic value of radiation treatment time deviation in nasopharyngeal carcinoma receiving intensity-modulated radiotherapy.iScience · 2026Article
- Epidemiological Assessment of Oral and Oropharyngeal Squamous Cell Carcinomas Before, During, and After the COVID-19 Pandemic, 2018-2024.Journal of clinical medicine · 2026Article
- Article
- ChatGPT-5 vs oral medicine experts for rank-based differential diagnosis of oral lesions: a prospective, biopsy-validated comparison.Odontology · 2026Article
- Review
- Missed Clinic Appointments for Human Papillomavirus-Related Oropharyngeal Cancer.Laryngoscope investigative otolaryngology · 2026Article
- Timing of adjuvant chemoradiotherapy after resection and survival in glioblastoma: a single-centre cohort analysis.Journal of neuro-oncology · 2026Article
- Timely Matters: Predictors of Delay in Oral Cavity Cancer Patients Across the Care Continuum.Laryngoscope investigative otolaryngology · 2026Article
- NIR-II biomimetic nanoplatform optogenetic CD274 editing of HNSCC immunogenicity for enhanced photoimmunotherapy.Materials today. Bio · 2026Article
- Impact of Treatment Package Time on Survival in Patients with Head and Neck Adenoid Cystic Carcinoma.Cancers · 2026Article
- Characterizing Treatment Delays in Patients With HPV-Negative Oropharyngeal Cancer.Cancer medicine · 2026Article
- Racial and socioeconomic disparities from time of diagnosis to treatment for small renal masses.BJUI compass · 2026Article
- Supportive Care Needs Among Pretreatment Head and Neck Cancer Patients According to Smoking Status: A Cross-Sectional Study With Nested Analyses.Laryngoscope investigative otolaryngology · 2026Article
118 more citing papers are in PubMed but not listed here.
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Abstract
purposeTo estimate the overall survival (OS) impact from increasing time to treatment initiation (TTI) for patients with head and neck squamous cell carcinoma (HNSCC).
methodsUsing the National Cancer Data Base (NCDB), we examined patients who received curative therapy for the following sites: oral tongue, oropharynx, larynx, and hypopharynx. TTI was the number of days from diagnosis to initiation of curative treatment. The effect of TTI on OS was determined by using Cox regression models (MVA). Recursive partitioning analysis (RPA) identified TTI thresholds via conditional inference trees to estimate the greatest differences in OS on the basis of randomly selected training and validation sets, and repeated this 1,000 times to ensure robustness of TTI thresholds.
resultsA total of 51,655 patients were included. On MVA, TTI of 61 to 90 days versus less than 30 days (hazard ratio [HR], 1.13; 95% CI, 1.08 to 1.19) independently increased mortality risk. TTI of 67 days appeared as the optimal threshold on the training RPA, statistical significance was confirmed in the validation set (P < .001), and the 67-day TTI was the optimal threshold in 54% of repeated simulations. Overall, 96% of simulations validated two optimal TTI thresholds, with ranges of 46 to 52 days and 62 to 67 days. The median OS for TTI of 46 to 52 days or fewer versus 53 to 67 days versus greater than 67 days was 71.9 months (95% CI, 70.3 to 73.5 months) versus 61 months (95% CI, 57 to 66.1 months) versus 46.6 months (95% CI, 42.8 to 50.7 months), respectively (P < .001). In the most recent year with available data (2011), 25% of patients had TTI of greater than 46 days.
conclusionTTI independently affects survival. One in four patients experienced treatment delay. TTI of greater than 46 to 52 days introduced an increased risk of death that was most consistently detrimental beyond 60 days. Prolonged TTI is currently affecting survival.
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