title: Treatment delays in oral cavity squamous cell carcinoma and association with survival.
abstract: Treatment durations and factors associated with delays for oral cavity squamous cell carcinoma (SCC) have previously been described but are not fully understood. Impact of delays on overall survival (OS) remains unclear.
  
  
  
  The National Cancer Data Base (NCDB) was used to analyze 4868 patients with oral cavity SCC from 1998 to 2011. Diagnosis-to-surgery, surgery-to-radiotherapy (RT)start, RT duration, total treatment package (surgery-to-RTend), and diagnosis-to-RTendwere evaluated. Associations between delays and various factors were analyzed using binary logistic regression. Associations with OS were analyzed using the Cox proportional hazards model.
  
  
  
  Medians for diagnosis-to-surgery, surgery-to-RTstart, RT duration, total treatment package, and diagnosis-to-RTendwere 30, 50, 49, 101, and 136 days, respectively. Age ≥60 years, uninsured or Medicaid insurance, comorbidity, late pT, and treatment at an academic/research institution were associated with diagnosis-to-surgery delays. Only delays in RT duration were significantly associated with decreased OS (hazard ratio [HR] = 1.21; p = .02).
  
  
  
  Numerous factors are associated with treatment delays. RT duration is significantly associated with OS. © 2017 Wiley Periodicals, Inc. Head Neck 39: 639-646, 2017.
authors.affiliation: Department of Surgery (Otolaryngology), Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Rance J T
authors.initials: RJ
authors.lastname: Fujiwara
authors.affiliation: Department of Surgery (Otolaryngology), Yale University School of Medicine, New Haven, Connecticut.|Yale Cancer Center, New Haven, Connecticut.
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Judson
authors.affiliation: Department of Surgery (Otolaryngology), Yale University School of Medicine, New Haven, Connecticut.|Yale Cancer Center, New Haven, Connecticut.
authors.forename: Wendell G
authors.initials: WG
authors.lastname: Yarbrough
authors.affiliation: Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut.|Yale Cancer Center, New Haven, Connecticut.
authors.forename: Zain
authors.initials: Z
authors.lastname: Husain
authors.affiliation: Department of Surgery (Otolaryngology), Yale University School of Medicine, New Haven, Connecticut.|Yale Cancer Center, New Haven, Connecticut.
authors.forename: Saral
authors.initials: S
authors.lastname: Mehra
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D002423:Cause of Death; D059186:Chemoradiotherapy, Adjuvant; D015331:Cohort Studies; D003131:Combined Modality Therapy; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D000077195:Squamous Cell Carcinoma of Head and Neck; D016019:Survival Analysis; D061665:Time-to-Treatment; D014481:United States
keywords: health services; oral cancer; outcome measures; quality of health care; time factors