Survey to Assess the Practice Patterns of Induction Chemotherapy (IC) in Head and Neck Cancer Patients

Abstract

To investigate practice patterns of use of IC amongst oncologists in treatment of head and neck cancer (HNC) patients. An IRB approved survey was sent using Red Cap software to oncologists registered on the American Society of Radiation Oncology (ASTRO) website. Variables were subjected to analysis with Fisher’s exact test. Data analysis was considered significant at Bonferroni adjusted p=0.05 threshold if the p-value was≤ 0.001 and suggestive if p<0.05.The survey was sent to 6818 unique email addresses. The response rate was 14.9% of US and 4.6% of international practitioners. 371 (98.4%) of participants were radiation oncologists. Participants identified as their practice type as Private Practice (23.9%), Academic (44.6%), Hospital Based (30.8%). Level of experience was “still in training” (15.4%), <1 year after completion of training (3.4%), 1-5 years (17.5%), 6-10 years (13.5%), 11-20 years (17.8%), 20-30 years (19.6%), and >30 years (12.7%). 56.8% participants treated >20 HNC patients yearly. 52.5% felt that there are some scenarios where IC improves cancer control and 57.8% felt that there were some scenarios where IC improves quality of life (QOL) outcomes for patients with locally advanced HNC. There was no difference between type of practice or level of training and feelings regarding IC in improving outcomes. Non US practitioners were more likely to feel that IC improved QOL (p=0.03) and were more likely to use IC (p=0.005). Increased volume of HNC patients treated was correlated with an increased use of IC (p=0.001). HNC patient volume was correlated with use of IC in a borderline laryngeal preservation (p= 0.006), bulky cervical lymph node (p=0.0005), and optic structure impinging tumor (p=0.007) case. Variability in use of IC was high. In a patient with a bulky lymph node, 30.5% of respondents rated their willingness to use IC at 0 of a 5 on a 5 point scale, 10.6% at 1, 8% at 2, 11.9% at 3, 15.1% at 4 and 19.9% at 5. In a case with tumor impinging on the optic structures, 25.2% of respondents rated their willingness to use IC at 0 of 5, 9.5% at 1, 12.7% at 2, 14.6% at 3, 17.5% at 4 and 16.7% at 5. After a complete response to IC, doses recommended were 70 Gy (54.6%), >60 but <70 Gy (34.1%), and 60 Gy (8.9%). For a patient with a partial response to IC with a decreased size of a lymph node mass, participants were divided on the dose to treat the areas that were previously involved with tumor, treating with <60 Gy (1.4%), 60 Gy (18%), >60 but <70 Gy (36.3%), 70 Gy (41.1%) and >70 Gy (3.5%). Practice patterns regarding the use of IC were highly varied. IC was most often recommended in patients with bulky cervical lymph node burden or a tumor impinging on the optic structures. Use of IC correlated with patient volume and country of practice.