Correlation of radiation treatment interruptions with psychiatric disease and performance status in head and neck cancer patients

Abstract

The purpose of this study is to identify factors predictive of treatment interruptions during radiation therapy (RT) for head and neck cancer. The medical records of 280 consecutive patients who completed a 6- or 7-week course of RT for squamous cell carcinoma of the head and neck were reviewed. The number of missed treatment days, excluding those due to holidays or machine downtime, was determined for each patient. All patients were treated to a median dose of 63Gy (range, 60 to 70Gy). The proportion of patients who missed 0, 3-5, 6-10, and greater than 10days was 25, 59, 12, and 5%, respectively. The percentage of patients who missed greater than 5days was 62% among the 39 patients with Karnofsky Performance Status (KPS) score of 70 or less compared to 10% among those with a KPS score of greater than 70 (p < 0.01). Among the 33 patients identified with a preexisting psychiatric condition, the percentage that subsequently missed greater than 5days of treatment was 48% compared to 13% among those without a psychiatric condition. When missed RT days were analyzed as a continuous variable, the correlations with both KPS and preexisting psychiatric condition remained highly significant (p < 0.01, for both). Poor performance status and preexisting psychiatric condition predicted for treatment interruptions during RT for head and neck cancer. In view of the possible detrimental effect on treatment outcome, appropriate social programs should be initiated to overcome potential barriers to RT for these particular populations.