S165 – Locally Advanced Head and Neck Cancer Treatment Patterns

Abstract

Objectives We assessed the extent of chemoradiation therapy (CRT) or high-dose platinum-based chemotherapy plus radiation (P-CRT) initiation for patients with stage III/IV, locally advanced head and neck cancer (LAHNC) treated in the VA New England Healthcare System (VA-NEHS), and identified the factors associated with such initiation. Methods Newly diagnosed LAHNC patients treated in the VA-NEHS (from 1996 to 2006) were identified from electronic records. Patients’ tumor staging (TNM), demographics, performance score, comorbidities, alcohol and tobacco use or dependence, and diagnosis year were abstracted via chart review. The primary outcome was the initial treatment strategy, grouped as CRT ± surgery (including P-CRT), chemotherapy (CT) ± surgery, radiation therapy (RT) ± surgery, surgery alone, or no treatment. Multiple logistic regressions compared odds of failure to initiate CRT or P-CRT across the aforementioned patient characteristics. Results Of 496 patients identified, 34.5%, 34.7%, 6.7%, and 5.4% initiated CRT, RT, CT, and surgery alone, respectively, whereas 18.8% were untreated. Most patients initiating CRT (59.7%) or CT (51.5%) received platinum-based chemotherapy. Predictors of failure to initiate CRT included diagnosis year 2002 (OR=3.57, 95% CI: 2.32, 5.55), age >65 years old (OR=2.47, 95% CI: 1.55, 3.92), performance score <90 (OR=2.27, 95% CI: 1.43, 3.59), and past/present alcohol use (OR=1.95, 95% CI: 1.08, 3.52). Similar factors predicted failure to initiate P-CRT. Conclusions Although CRT/P-CRT initiation increased over time, older patients, patients with poorer performance status, and those using alcohol were less likely to initiate CRT. Research is needed to describe treatment outcomes in LAHNC patients not initiating CRT/P-CRT.