ArticleCancer2018
Quantitative survival impact of composite treatment delays in head and neck cancer.
Article in Cancer, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 45 papers, 3 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
45 citing papers in PubMed, 3 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
- Delayed Postoperative Radiotherapy in Head & Neck Cancers-A Systematic Review and Meta-Analysis.The Laryngoscope · 2025Pooled it
- Delays Starting Postoperative Radiotherapy Among Head and Neck Cancer Patients: A Systematic Review and Meta-analysis.Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · 2024Pooled it
- Randomized Trial of Enhanced Versus Standard Navigation to Promote Timely Initiation of Adjuvant Radiotherapy for Head and Neck Cancer.JCO oncology practice · 2025Trial
- A Discharge Summary Prompt Reduces Postoperative Radiotherapy Delay in Head and Neck Cancer Patients.Head & neck · 2026Article
- Barriers and Facilitators to Timely Adjuvant Therapy for Head and Neck Cancer in Rural Care.JAMA otolaryngology-- head & neck surgery · 2026Article
- Missed Clinic Appointments for Human Papillomavirus-Related Oropharyngeal Cancer.Laryngoscope investigative otolaryngology · 2026Article
- Improving Patient Wait Times on the First Day of Radiotherapy Treatment.South Asian journal of cancer · 2025Article
- Optimal timing of cancer treatments: a call for emerging evidence from clinical trials and real-world studies.British journal of cancer · 2025Review
- Effect of delayed treatment on survival of patients with head and neck squamous cell cancer.Scientific reports · 2025Article
- Impact of Surgeon-Radiation Oncology Dyads in Oral Cavity Cancer Outcomes.Annals of surgical oncology · 2025Article
- Article
- Radiation dermatitis in the hairless mouse model mimics human radiation dermatitis.Scientific reports · 2024Article
- Patient Navigation for Timely, Guideline-Adherent Adjuvant Therapy for Head and Neck Cancer: A National Landscape Analysis.Journal of the National Comprehensive Cancer Network : JNCCN · 2023Article
- Oncologic Significance of Therapeutic Delays in Patients With Oral Cavity Cancer.JAMA otolaryngology-- head & neck surgery · 2023Article
- Update on adherence to guidelines for time to initiation of postoperative radiation for head and neck squamous cell carcinoma.Head & neck · 2023Article
- Association of Social-Ecological Factors With Delay in Time to Initiation of Postoperative Radiation Therapy: A Prospective Cohort Study.JAMA otolaryngology-- head & neck surgery · 2023Article
- Head and neck cancer treatment outcome priorities: A multi-perspective concept mapping study.PloS one · 2023Article
- ED visits, hospital admissions and treatment breaks in head/neck cancer patients undergoing radiotherapy.Frontiers in oncology · 2023Article
- THE IMPACT OF COVID-19 ON HEAD AND NECK CANCER TREATMENT DELAY.Acta clinica Croatica · 2022Article
Corrections and comments
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Authors and funding
12 authors.
Funding
Abstract
backgroundMultidisciplinary management of head and neck cancer (HNC) must reconcile increasingly sophisticated subspecialty care with timeliness of care. Prior studies examined the individual effects of delays in diagnosis-to-treatment interval, postoperative interval, and radiation interval but did not consider them collectively. The objective of the current study was to investigate the combined impact of these interwoven intervals on patients with HNC.
methodsPatients with HNC who underwent curative-intent surgery with radiation were identified in the National Cancer Database between 2004 and 2013. Multivariable models were constructed using restricted cubic splines to determine nonlinear relations with overall survival.
resultsOverall, 15,064 patients were evaluated. After adjustment for covariates, only prolonged postoperative interval (P < .001) and radiation interval (P < .001) independently predicted for worse outcomes, whereas the association of diagnosis-to-treatment interval with survival disappeared. By using multivariable restricted cubic spline functions, increasing postoperative interval did not affect mortality until 40 days after surgery, and each day of delay beyond this increased the risk of mortality until 70 days after surgery (hazard ratio, 1.14; 95% confidence interval, 1.01-1.28; P = .029). For radiation interval, mortality escalated continuously with each additional day of delay, plateauing at 55 days (hazard ratio, 1.25; 95% confidence interval, 1.11-1.41; P < .001). Delays beyond these change points were not associated with further survival decrements.
conclusionsIncreasing delays in postoperative and radiation intervals are associated independently with an escalating risk of mortality that plateaus beyond certain thresholds. Delays in initiating therapy, conversely, are eclipsed in importance when appraised in conjunction with the entire treatment course. Such findings may redirect focus to streamlining those intervals that are most sensitive to delays when considering survival burden. Cancer 2018. © 2018 American Cancer Society.
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