Yu Karina, Westbrook Marisa, Brodie Shauna, Lisker Sarah, Vittinghoff Eric, Hua Vivian, Russell Marika, Sarkar Urmimala
Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Department of Health and Behavioral Sciences, University of Colorado, Denver, Denver, Colorado, USA.
OTO Open. 2020 Feb 6;4(1):2473974X19900761. doi: 10.1177/2473974X19900761. eCollection 2020 Jan-Mar.
Treatment delays and suboptimal adherence to posttreatment surveillance may adversely affect head and neck cancer (HNC) outcomes. Such challenges can be exacerbated in safety-net settings that struggle with limited resources and serve a disproportionate number of patients vulnerable to gaps in care. This study aims to characterize treatment delays and adherence with posttreatment surveillance in HNC care at an urban tertiary care public hospital in San Francisco.
Retrospective chart review.
Urban tertiary care public hospital in San Francisco.
We identified all cases of HNC diagnosed from 2008 to 2010 through the electronic medical record. We abstracted data, including patient characteristics, disease characteristics, pathology and radiology findings, treatment details, posttreatment follow-up, and clinical outcomes.
We included 64 patients. Median time from diagnosis to treatment initiation (DTI) was 57 days for all patients, 54 days for patients undergoing surgery only, 49 days for patients undergoing surgery followed by adjuvant radiation ± chemotherapy, 65 days for patients undergoing definitive radiation ± chemotherapy, and 29 days for patients undergoing neoadjuvant chemotherapy followed by radiation or chemoradiation. Overall, 69% of patients completed recommended treatment. Forty-two of 61 (69%) patients demonstrated adherence to posttreatment visits in year 1; this fell to 14 out of 30 patients (47%) by year 5.
DTI was persistently prolonged in this study compared with prior studies in other public hospital settings. Adherence to posttreatment surveillance was suboptimal and continued to decline as the surveillance period progressed.
治疗延迟以及对治疗后监测的依从性欠佳可能会对头颈癌（HNC）的治疗结果产生不利影响。在资源有限且服务大量易出现护理缺口的弱势患者的安全网环境中，这些挑战可能会更加严峻。本研究旨在描述旧金山一家城市三级护理公立医院HNC护理中的治疗延迟情况以及对治疗后监测的依从性。
回顾性病历审查。
旧金山的城市三级护理公立医院。
我们通过电子病历识别出2008年至2010年期间诊断的所有HNC病例。我们提取了数据，包括患者特征、疾病特征、病理和放射学检查结果、治疗细节、治疗后随访情况以及临床结局。
我们纳入了64例患者。所有患者从诊断到开始治疗（DTI）的中位时间为57天，仅接受手术的患者为54天，接受手术并辅助放疗±化疗的患者为49天，接受根治性放疗±化疗的患者为65天，接受新辅助化疗后再进行放疗或放化疗的患者为29天。总体而言，69%的患者完成了推荐治疗。61例患者中有42例（69%）在第1年坚持进行了治疗后随访；到第5年，这一比例降至30例患者中的14例（47%）。
与其他公立医院环境中的先前研究相比，本研究中的DTI持续延长。对治疗后监测的依从性欠佳，且随着监测期的推进持续下降。
