title: Evaluation of Factors in Relation with the Non-Compliance to Curative Intent Radiotherapy among Patients of Head and Neck Carcinoma: A Study from the Kumaon Region of India.
abstract: BACKGROUND
  Radiotherapy (RT)-based curative regimens for head and neck squamous cell carcinomas (HNSCC) deliver a dose of 66-70 Gray (Gy) over a period of 6-7 weeks, and incomplete treatments are unlikely to result in cure. Non-compliance to RT is major contributory factor to treatment failure.
  
  
  OBJECTIVE
  To assess the proportion of patients who do not complete planned treatment after initiation of curative RT. This study also aims to explore a possible relationship of non-compliance due to socio-economic, disease-related and treatment-related factors.
  
  
  METHODS
  The records of HNSCC patients treated from January 2012-December 2013 were audited. Data from the treatment records were to collect patient-related, disease-related, and social demographic parameters. Of the patients who had not completed treatment, the reasons behind the same were investigated.
  
  
  RESULTS
  Of the 324 patients of HNSCC who were initiated on radical RT, a total of 76 patients were found to have discontinued treatment without authorization of the treating clinician. There was no significant predilection for treatment non-compliance with regards to patient age, educational status, religion, site of the disease, use of neoadjuvant chemotherapy, or use of concurrent chemotherapy. There tended to be a higher association of treatment non-compliance among patients residing >100 km away from the treatment center, patients hailing from hilly regions, patients without the below poverty line (BPL) card, unemployed patients, and patients with stage IV-A/B disease. Of the 76 patients who did not complete treatment, telephonic questionnaire could be obtained from 54 patients. Causes for non-compliance included preference for traditional healers (22.2%), fear of toxicity (7.4%), logistic reasons (18.5%), financial reasons (24.1%), and lack of interest/faith in RT (5.6%).
  
  
  CONCLUSIONS
  There is a high incidence of treatment default among patients of HNSCC during RT in this region. The revelation of the higher propensity for treatment default among patients from distant, hilly regions, unemployed, patients without BPL cards, and stages-IVA/IVB highlights the need for specific interventions for these special populations.
authors.affiliation: Department of Radiotherapy, Swami Rama Cancer Hospital and Research Institute, Government Medical College, Haldwani, Nainital, Uttarakhand, India.
authors.forename: Kailash Chandra
authors.initials: KC
authors.lastname: Pandey
authors.affiliation: Department of Radiotherapy, Swami Rama Cancer Hospital and Research Institute, Government Medical College, Haldwani, Nainital, Uttarakhand, India.
authors.forename: Swaroop
authors.initials: S
authors.lastname: Revannasiddaiah
authors.affiliation: Department of Radiotherapy, Swami Rama Cancer Hospital and Research Institute, Government Medical College, Haldwani, Nainital, Uttarakhand, India.
authors.forename: Nirdosh Kumar
authors.initials: NK
authors.lastname: Pant
keywords: Head and neck cancer; Non-compliance; Radiotherapy; Socio-economic factors; Treatment default