Impact of outside referral and dental extractions on package time with post-operative radiation therapy for head and neck cancer.

Abstract

Patients with squamous cell carcinoma of the head and neck (HNSCC) often receive post-operative radiotherapy (RT). A package time between surgery and completion of RT of ≤100 days is associated with lower recurrence and longer survival. In this study, we investigate the impact of outside referral and dental extractions on package time, with secondary detriment to relapse-free survival (RFS) and overall survival (OS). We conducted a retrospective chart review on patients with HNSCC who received primary surgical resection at an academic medical centre. Ninety-four patients met eligibility criteria, 35% experienced recurrence, and 21% died. Median package time was 89.5 days, with 76% of patients achieving a package time ≤100 days. Receiving RT in-house was associated with a shorter package time (P = 0.0004) and higher completion rate within 100 days (P = 0.01). Dental extractions did not affect package time. A Kaplan-Meier analysis was performed to study survival, and a package time ≤100 days was not associated with a change in RFS or OS. A Cox proportional hazard model was used to investigate other factors hypothesized to impact patient survival; none had an effect on RFS, but cancer stage had an effect on OS (P = 0.01). We identified that outside referrals, but not dental extractions, prolong treatment package times. We also saw no effect of package time on RFS or OS. These results suggest that patients requesting outside facility referrals for RT may benefit from a streamlined program that expedites the referral process.