Missed radiation therapy sessions in first three weeks predict distant metastasis and less favorable outcomes in surgically treated patients with oral cavity squamous cell carcinoma

Factors Associated With Early Discontinuation of Radiation Therapy: An Analysis of the National Cancer Database

Purpose

Radiation therapy (RT) often involves multiple visits over weeks and may be discontinued before planned treatment completion. This analysis aims to identify clinical and socioeconomic factors that could serve as predictors of RT discontinuation.

Methods and Materials

Using National Cancer Database data from 2018 to 2019, we identified 749,135 cases treated with RT, chemoradiation (CRT), surgery with RT, or surgery with CRT that had information on radiation discontinuation. All patients were treated with curative intent. The variables assessed include age (18-<50, 50-<70, and ≥70), sex (male and female), race (White, Black, and Other), insurance status (private, Medicare/government, and Medicaid/uninsured), income level (<$46,277, $46,277-$57,856, $57,856-$74,062, and ≥$74,062), facility type (community, comprehensive community, academic/research, and integrated cancer network), Charlson-Deyo Comorbidity Score (0, 1, and ≥2), treatment type (RT, CRT, surgery with RT, and surgery with CRT), and primary tumor site. Reasons for RT discontinuation were evaluated. Univariable and multivariable logistic regression modeling was used to calculate the adjusted odds of RT discontinuation by clinical and socioeconomic factors.

Results

Of the 749,135 patients, RT was discontinued in 25,072 (3.3%) patients. The primary tumor sites include breast (36.6%), thorax (18.1%), genitourinary tract (13.2%), head and neck (11.4%), gastrointestinal system (10.9%), gynecologic system (6.0%), central nervous system (3.9%), musculoskeletal system (1.3%), and skin (0.7%). On multivariable analysis, older age, female sex, nonprivate insurance, lower income, treatment at community program facilities, multiple comorbidities, and CRT were independently associated with RT discontinuation. The reasons for RT discontinuation were patient decision (35.5%), contraindication because of patient risk factors (20.0%), toxicity (19.7%), patient expiration (13.8%), and family decision (3.0%).

Conclusions

This National Cancer Database analysis showed RT discontinuation rates correlated with clinical factors, including older age, multiple comorbidities, and CRT, and socioeconomic factors, including nonprivate insurance and lower household income.

Language barriers in head and neck cancer: Matched pair analysis of outcomes between non-English speaking and English-speaking patients

PURPOSE

As society grows in cultural diversity, an increasing proportion of patients are expected to be from non-English speaking backgrounds. This study sought to compare the clinical outcomes between non-English speakers and English speakers treated by radiation therapy for head and neck cancer.

METHODS AND MATERIALS

Seventy-five non-English speaking patients with squamous cell carcinoma of the head and neck were matched to English-speaking controls based on patient and disease variables; clinical outcomes were compared.

RESULTS

Non-English speaking patients had inferior 3-year overall survival (64% vs. 77%, p = 0.02) and progression-free survival (59% vs. 73%, p = 0.01) compared with the English-speaking cohort. On logistical regression, non-English-speaking status was associated with a significantly increased risk of overall death (OR = 1.41; 95% CI, 1.09-1.92).

CONCLUSIONS

Prognosis differed significantly between non-English speaking and English-speaking patients. Culturally tailored programs to address language barriers should be considered to ameliorate disparities in outcome.

Determining the impact of COVID-19 pandemic on adjuvant therapy for oral cancer - A matched-pair analysis

Background

The ongoing coronavirus disease 2019 (COVID-19) pandemic has hard-pressed the health care systems beyond their capabilities, causing a lack of appropriate cancer treatment delivery. The aim of this study was to assess the impact of pandemic-related restrictions on adjuvant therapy delivery for oral cancer patients during these demanding times.

Materials and Methods

Oral cancer patients who were operated on between February and July 2020 and scheduled to receive prescribed adjuvant therapy during the COVID-19-related restrictions (Group I) were included in the study. The data were matched for the length of hospital stay and type of prescribed adjuvant therapy, with a set of patients who were similarly managed 6 months preceding the restrictions (Group II). Demographic and treatment-specific details, including inconveniences faced in procuring prescribed treatment, were obtained. Factors associated with delay in receiving adjuvant therapy were compared using regression models.

Results

A total of 116 oral cancer patients were considered for analysis, comprising 69% (n = 80) adjuvant radiotherapy alone and 31% (n = 36) concurrent chemoradiotherapy. The mean hospital stay was 13 days. In Group I, 29.3% (n = 17) of patients were not able to receive any form of their prescribed adjuvant therapy at all, which was 2.43 times higher than Group II (P = 0.038). None of the disease-related factors significantly predicted delay in receiving adjuvant therapy. Of the delay, 76.47% (n = 13) was present during the initial part of the restrictions, with the most common reason being unavailability of appointments (47.1%, n = 8), followed by inability to reach treatment centers (23.5%, n = 4) and redeem reimbursements (23.5%, n = 4). The number of patients who were delayed the start of radiotherapy beyond 8 weeks after surgery was double in Group I (n = 29) than in Group II (n = 15; P = 0.012).

Conclusions

This study highlights a small part of the rippling effect the COVID-19 restrictions have on oral cancer management and pragmatic actions may be needed by policymakers to deal with such challenges.