Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City.
Department of Radiation Oncology, University of Kansas Medical Center, Kansas City.
JAMA Otolaryngol Head Neck Surg. 2023 Jun 1;149(6):477-484. doi: 10.1001/jamaoto.2023.0308.
Timely initiation of postoperative radiation therapy (PORT) is associated with reduced recurrence rates and improved overall survival in patients with head and neck squamous cell carcinoma (HNSCC). Measurement of the association of social-ecological variables with PORT delays is lacking.
To assess individual and community-level factors associated with PORT delay among patients with HNSCC.
DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study carried out between September 2018 and June 2022 included adults with untreated HNSCC who were enrolled in a prospective registry at a single academic tertiary medical center. Demographic information and validated self-reported measures of health literacy were obtained at baseline visits. Clinical data were recorded, and participant addresses were used to calculate the area deprivation index (ADI), a measure of community-level social vulnerability. Participants receiving primary surgery and PORT were analyzed. Univariable and multivariable regression analysis was performed to identify risk factors for PORT delays.
Surgical treatment and PORT.
The primary outcome was PORT initiation delay (>42 days from surgery). Risk of PORT initiation delay was evaluated using individual-level (demographic, health literacy, and clinical data) and community-level information (ADI and rural-urban continuum codes).
Of 171 patients, 104 patients (60.8%) had PORT delays. Mean (SD) age of participants was 61.0 (11.2) years, 161 were White (94.2%), and 105 were men (61.4%). Insurance was employer-based or public among 65 (38.5%) and 75 (44.4%) participants, respectively. Mean (SD) ADI (national percentile) was 60.2 (24.4), and 71 (41.8%) resided in rural communities. Tumor sites were most commonly oral cavity (123 [71.9%]), with 108 (63.5%) classified as stage 4 at presentation. On multivariable analysis, a model incorporating individual-level factors with health literacy in addition to community-level factors was most predictive of PORT delay (AOC= 0.78; R2, 0.18).
This cohort study provides a more comprehensive assessment of predictors of PORT delays that include health literacy and community-level measures. Predictive models that incorporate multilevel measures outperform models with individual-level factors alone and may guide precise interventions to decrease PORT delay for at-risk patients with HNSCC.
对头颈鳞状细胞癌（HNSCC）患者及时进行术后放射治疗（PORT）与降低复发率和提高总体生存率有关。缺乏与 PORT 延迟相关的社会生态变量的测量。
评估与 HNSCC 患者 PORT 延迟相关的个体和社区水平因素。
设计、地点和参与者：这项前瞻性队列研究于 2018 年 9 月至 2022 年 6 月期间进行，纳入了在一家学术性三级医疗中心的前瞻性登记处接受未经治疗的 HNSCC 的成年人。在基线就诊时，获得了人口统计学信息和经过验证的健康素养自我报告测量。记录了临床数据，并使用参与者的地址计算了地区贫困指数（ADI），这是衡量社区社会脆弱性的一种措施。对接受主要手术和 PORT 的患者进行了分析。进行了单变量和多变量回归分析，以确定 PORT 延迟的危险因素。
手术治疗和 PORT。
主要结局是 PORT 起始延迟（手术 42 天后）。使用个体水平（人口统计学、健康素养和临床数据）和社区水平信息（ADI 和城乡连续统一体代码）评估 PORT 起始延迟的风险。
在 171 名患者中，有 104 名（60.8%）患者出现 PORT 延迟。参与者的平均（SD）年龄为 61.0（11.2）岁，161 人是白人（94.2%），105 人是男性（61.4%）。分别有 65 名（38.5%）和 75 名（44.4%）参与者的保险为雇主或公共保险。平均（SD）ADI（全国百分位数）为 60.2（24.4），71 名（41.8%）居住在农村社区。肿瘤部位最常见于口腔（123 例[71.9%]），108 例（63.5%）为疾病分期 4 期。多变量分析表明，同时包含个体水平因素和健康素养的模型比仅包含个体水平因素的模型更能预测 PORT 延迟（AOC=0.78；R2，0.18）。
这项队列研究提供了对头颈鳞状细胞癌患者 PORT 延迟预测因素的更全面评估，其中包括健康素养和社区水平的措施。纳入多层次措施的预测模型优于仅包含个体水平因素的模型，并且可能为高危头颈癌患者减少 PORT 延迟提供精确的干预措施。
