Departments of Radiation Oncology, University of California, Irvine, Chao Family Comprehensive Cancer Center, Orange, CA 92868, USA.
Departments of Radiation Oncology, University of California, Irvine, Chao Family Comprehensive Cancer Center, Orange, CA 92868, USA.
Oral Oncol. 2023 Dec;147:106611. doi: 10.1016/j.oraloncology.2023.106611. Epub 2023 Nov 11.
To evaluate the influence of socioeconomic and demographic factors which might predict for excessive delays in the receipt of adjuvant radiotherapy for head and neck cancer.
The medical records of 430 consecutive patients referred for adjuvant radiation after surgical resection for squamous cell carcinoma of the head and neck were reviewed. The number of days from surgery to initiation of radiation was recorded. To study the variability in which adjuvant radiation was delivered, descriptive statistics were used to determine the percentage of patients who deviated from starting treatment beyond the recommended benchmark of 42 days. The chi-square statistic was used to compare differences in proportion among subsets. A Cox proportional hazards model was constructed to perform a multi-variate analysis to identify factors which independently influenced the likelihood for non-adherence.
The interval between surgery and the start of radiation therapy ranged from 5 to 128 days (mean, 36 days). The mean number of days from surgery to radiation therapy was 31 days, 35 days, 40 days, and 42 days for Caucasians, Asians, Latino, and Black patients (p = 0.01). In all, 359 of 430 patients (83 %) started adjuvant radiation within 42 days. The proportion of patients who initiated radiation therapy within 42 days of surgery was 91 %, 86 %, 71 %, 65 %, and 80 % for Caucasians, Asians, Latinos, Blacks, and Native Hawaiian/Pacific Islanders, respectively (p < 0.001). Patient characteristics associated with higher odds of non-adherence to the timely receipt of adjuvant radiation therapy within then 42-day benchmark from surgery to radiation included race ([OR] = 4.23 95 % CI (1.30-7.97), non-English speaking status ([OR] = 2.38, 95 % CI: 0.61-4.50), and low socioeconomic status ([OR] = 1.21, 95 % CI: 1.01-1.86).
Underrepresented minorities are more likely to experience delays in the receipt of adjuvant radiation for head and neck cancer. The potential underlying reasons are discussed.
评估社会经济和人口统计学因素对接受头颈部癌症辅助放疗的延迟的影响。
回顾了 430 例连续接受手术切除后辅助放疗的鳞状细胞癌患者的病历。记录了从手术到开始放疗的天数。为了研究辅助放疗的可变性，使用描述性统计数据来确定超出推荐的 42 天基准的患者的比例。使用卡方检验比较亚组之间的比例差异。构建 Cox 比例风险模型进行多变量分析，以确定独立影响不遵医嘱的可能性的因素。
手术与放射治疗之间的间隔时间为 5 至 128 天（平均 36 天）。从手术到放射治疗的平均天数为 31 天、35 天、40 天和 42 天，分别为白种人、亚洲人、拉丁裔和黑人患者（p=0.01）。共有 430 例患者中的 359 例（83%）在 42 天内开始辅助放疗。在手术 42 天内开始放射治疗的患者比例分别为白种人 91%、亚洲人 86%、拉丁裔 71%、黑人和夏威夷/太平洋岛民 65%和 80%（p<0.001）。与手术至放疗 42 天内未能及时接受辅助放疗的几率较高相关的患者特征包括种族（OR=4.23，95%CI：1.30-7.97）、非英语语言状态（OR=2.38，95%CI：0.61-4.50）和低社会经济地位（OR=1.21，95%CI：1.01-1.86）。
代表性不足的少数族裔更有可能延迟接受头颈部癌症的辅助放疗。讨论了潜在的原因。
