Treatment delays in laryngeal squamous cell carcinoma: A national cancer database analysis

Objective: To characterize treatment delays in laryngeal cancer and associate delays with patient, tumor, and treatment factors and with overall survival.

Methods: We identified 33,819 adults with laryngeal squamous cell carcinoma (LSCC) in the National Cancer Database from 2004 to 2013. We calculated durations of diagnosis-to-treatment initiation, surgery-to-adjuvant treatment, radiotherapy duration, total treatment package, and diagnosis-to-treatment end intervals. Delays were associated with patient, tumor, and treatment characteristics via multivariable logistic regression and with overall survival by Cox proportional hazards regression.

Results: Median durations of diagnosis-to-treatment initiation, surgery-to-radiation initiation, radiation treatment, total treatment package, and diagnosis-to-treatment end were 28, 42, 48, 91, and 107 days in surgical patients; median durations of diagnosis-to-treatment initiation, radiation treatment, and diagnosis-to-treatment end were 33, 50, and 85 days in nonsurgical patients. Race and insurance status were linked to delays in most intervals. Academic and high-volume facilities had less delayed radiation treatment but increased delays in most other intervals. Delayed surgery-to-radiation and total treatment package intervals were associated with overall survival in surgical patients (hazard ratio [HR] = 1.15 [1.03-1.29], P = 0.015; HR = 1.16 [1.02-1.31], P = 0.025). Diagnosis-to-treatment initiation and diagnosis-to-treatment end intervals were associated with overall survival in nonsurgical patients (HR = 1.08 [1.02-1.14], P = 0.007; HR = 1.09 [1.03-1.16], P = 0.003, respectively) but not in surgical patients (HR = 0.96 [0.87-1.06] P = 0.440; HR = 1.13 [0.99-1.29], P = 0.062). Radiation delays were associated with overall survival in surgical and nonsurgical patients (HR = 1.21 [1.09-1.36], P = 0.001; HR = 1.37 [1.30-1.44], P < 0.001).

Conclusion: These durations can serve as national benchmarks. Delays could be considered quality indicators in LSCC.

Level of evidence: 2b Laryngoscope, 128:2751-2758, 2018.