title: Factors predict prolonged wait time and longer duration of radiotherapy in patients with nasopharyngeal carcinoma: a multilevel analysis.
abstract: OBJECTIVE
  Radiotherapy with or without chemotherapy is the primary treatment for patients with nasopharyngeal carcinoma (NPC). It wastes time from diagnosis to treatment. Treatment time of radiotherapy generally takes at least seven weeks. The current study aimed to evaluate factors associated with prolonged wait time and longer duration of radiotherapy in NPC patients.
  
  
  METHODS
  From Taiwan's National Health Insurance research database, we identified 3,605 NPC patients treated with radiotherapy between 2008 and 2011. Wait time was calculated from the date of diagnosis to the start of radiotherapy. The impact of each variable on wait time and duration of radiotherapy was examined by multilevel analysis using a random-intercept model.
  
  
  RESULTS
  The mean wait time and duration of radiotherapy were 1.78±3.33 and 9.72±7.27 weeks, respectively. Multilevel analysis revealed prolonged wait time in patients aged 45-65 years, those receiving radiotherapy alone, those with more comorbidities, those with low SES, and those living in eastern Taiwan. A prolonged duration of radiotherapy was associated with receipt of concurrent chemoradiotherapy, more comorbidities, and moderate SES.
  
  
  CONCLUSIONS
  Understanding the factors associated with longer wait times and duration of radiotherapy in patients with NPC may help healthcare providers better assist both these patients and potentially those with other head-and-neck cancers.
authors.affiliation: Department of Radiation Oncology, Pingtung Christian Hospital, Pingtung, Taiwan.
authors.forename: Po-Chun
authors.initials: PC
authors.lastname: Chen
authors.affiliation: Department of Radiation Oncology, Chi-Mei Medical Center, Tainan, Taiwan.
authors.forename: Ching-Chieh
authors.initials: CC
authors.lastname: Yang
authors.affiliation: Department of Otolaryngology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Cheng-Jung
authors.initials: CJ
authors.lastname: Wu
authors.affiliation: Department of Radiation Oncology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Wen-Shan
authors.initials: WS
authors.lastname: Liu
authors.affiliation: Department of Radiation Oncology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Wei-Lun
authors.initials: WL
authors.lastname: Huang
authors.affiliation: Department of Otolarygology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; Cancer Center, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; School of Medicine, Tzu Chi University, Hualin, Taiwan.
authors.forename: Ching-Chih
authors.initials: CC
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002277:Carcinoma; D059248:Chemoradiotherapy; D002648:Child; D002675:Child, Preschool; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000532:radiotherapy*; D061665:Time-to-Treatment; D016896:Treatment Outcome; D055815:Young Adult