Real-world healthcare resource use and costs associated with the management of locally advanced head and neck cancer in Portugal - TRACE2 study.

Introduction: Approximately 60% of patients with head and neck squamous cell carcinoma are diagnosed with locally advanced disease (LA-HNSCC), which is associated with a high risk of recurrence, distant metastasis, and poor prognosis. A multidisciplinary approach is recommended for comprehensive care, resulting in a substantial burden on the healthcare system. The TRACE2 study aimed to describe patients' clinical characteristics, healthcare resource utilization (HCRU), and costs associated with LA-HNSCC management in real-world practice in Portugal. Methods: Non-interventional, retrospective cohort study conducted in four Portuguese hospitals between 30/11/2021-04/03/2024, including adult patients diagnosed between 01/06/2016-31/05/2018 who were eligible for curative treatment. Secondary data were collected from medical records from the time of diagnosis until recurrence, death, loss to follow-up, or the cut-off date (31/12/2020), whichever occurred first. The financial analysis was conducted from the perspective of the Portuguese public healthcare payer, considering only direct medical costs. Results: The study included 150 patients (94.7% male; 91.3% aged 50-79 years), with a high prevalence of tobacco (92.0%) and heavy alcohol (83.1%) use. Combined systemic therapy and radiotherapy (ST+RT) was the most frequent treatment (81.3%), whereas a minority underwent surgery (17.3%) or RT without ST (13.3%). During a median follow-up of 12 months, over 89% of patients required outpatient consultations and medical exams. Hospitalizations and emergency consultations were reported in 74.5% and 37.6% of patients, respectively. Overall, supportive care, including nutritional support (85.2%), psychological treatment (16.1%), and speech therapy (8.7%), were used by fewer patients. HCRU was generally higher during treatment than after its completion or discontinuation. The global median (P25; P75) annualized cost per patient was €7,706.0 (3,775.8; 20,784.8), with the primary cost drivers being ST+RT and hospitalizations, followed by outpatient consultations and imaging assessments. Discussion: The TRACE2 study provides the first comprehensive description of LA-HNSCC management in real-world practice in Portugal, underscoring the burden on both patients and the healthcare system. Given the persistently high proportion of patients diagnosed with locally advanced disease, these findings offer supporting evidence for the implementation of measures to improve patient follow-up protocols and resource allocation, ultimately enhancing patient outcomes.