title: Head and neck radiotherapy compliance in an underserved patient population.
abstract: OBJECTIVE
  Compliance to intensive multiweek radiation therapy (RT) regimens in head and neck cancer (HNC) patients is challenging, particularly among medically underserved patients with fewer financial and social resources. Treatment prolongation reduces local control and overall survival rates, making adherence to treatment a key factor in optimal outcome. We evaluated factors affecting compliance in medically underserved patients who received RT for HNC in a large municipal hospital setting in New York City.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Treatment records of patients treated between July 2004 and August 2008 were reviewed. Number of and reasons for missed treatments were identified. Several demographic, toxicity, and treatment variables were analyzed for impact on compliance.
  
  
  RESULTS
  Eighty consecutive HNC patients who underwent RT with a 5- to 7-week regimen were identified. Thirty-two patients (40%) missed no treatments, 36 (45%) missed one to six treatments, six (8%) missed seven to 14 treatments, two (3%) missed more than 14 treatments, and four (5%) did not complete treatment. Reasons for missed treatments were hospitalization (31% of events) and toxicity (20%). Patients with percutaneous endoscopic gastrostomy tube were more likely to miss treatments (P = .01, chi(2) test). No other variable showed a significant association with missed treatments (chi(2) test).
  
  
  CONCLUSIONS
  Intensive RT for HNC can be delivered with very good adherence within a medically underserved population. Eighty-five percent of patients completed treatment with 0 to 6 days of interruption. Efforts to further improve adherence in this population are ongoing.
authors.affiliation: Department of Radiation Oncology, New York University Langone Medical Center and New York University School of Medicine New York, New York, USA.
authors.forename: Rajni A
authors.initials: RA
authors.lastname: Sethi
authors.forename: Emily F
authors.initials: EF
authors.lastname: Stamell
authors.forename: Leah
authors.initials: L
authors.lastname: Price
authors.forename: Mark
authors.initials: M
authors.lastname: DeLacure
authors.forename: Nicholas
authors.initials: N
authors.lastname: Sanfilippo
mesh_terms: D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D009519:New York City; D010349:Patient Compliance; D012923:Social Class