Delays to treatment initiation in the management of head and neck cancer

This is the authors' abstract. We don't add key points for this paper.

Background: Prolonged treatment time for head and neck cancer has implications on morbidity and mortality. Disease progression can impact technique, modality and intent of treatment. Time to treatment initiation (TTI) exceeding 45 days from diagnosis correlates with an increased risk of mortality. Methods: The Royal Adelaide Hospital Department of Otolaryngology conducted a retrospective cohort study on all new head and neck cancer referrals from 2015 to identify delays to treatment initiation. Results: Ninety-one new cases of head and neck squamous cell carcinoma were treated with curative intent therapy. Seventy-five underwent surgery, 13 received primary radiotherapy with adjuvant chemotherapy and 3 received primary radiotherapy alone. The mean TTI from initial ENT surgical consultation to definitive treatment was 39.43 days (Standard Deviation 24.43.) There was a statistically significant disparity in treatment times (P<0.001) between surgical treatment (34.41 days) and non-surgical treatment (65.44 days). Factors that contributed to a prolonged treatment time included lack of diagnostic imaging at first consultation, invasive diagnostic procedures under general anaesthesia and inefficient scheduling of outpatient encounters. Conclusions: Head and neck cancer treatment is time and resource intensive process where delays can negatively impact patient outcomes. Strategies to reduce treatment times should remain a priority for all head and neck cancer departments. A streamlined pathway with effective communication and innovative diagnostic techniques can improve patient outcomes.