title: The impact of time to treatment initiation on survival from head and neck cancer in north-eastern Italy.
abstract: To evaluate the impact of time to treatment initiation (TTI) on overall survival in patients with head-and-neck squamous cell carcinoma (HNSCC).
  
  
  
  In the period 2003-2009, 1616 HNSCC patients were diagnosed in Friuli Venezia Giulia Region, Northeastern Italy, including 462 oral, 346 oropharyngeal, 212 hypopharyngeal, and 596 laryngeal cancers. Clinical information, including date and type of first treatment, and follow-up were retrieved from the regional Cancer Registry and a population-based health database collecting comprehensive health information on people living in the Region. Multivariate hazard ratio (HR) and confidence intervals (CI) were calculated through Cox model.
  
  
  
  Overall, the median TTI was 28days, (Q1-Q3: 13-45days), but significant variations emerged according to anatomical site, cancer stage, treatment approach, and care transition to specialized centers. Five-year overall survival decreased with increasing treatment delay from 62% for TTI<30days to 39% for TTI≥90days (p<0.01). HR of death was 1.13 (95% CI: 0.92-1.39) for TTI between 45-89days, and 1.47 (1.05-2.05) for TTI≥90days. The association between TTI and poor prognosis was stronger for laryngeal cancers and early-stage HNSCCs. Further, care transition from community hospitals to specialized centers was associated to a better prognosis (HR=0.73; 95% CI: 0.60-0.88).
  
  
  
  Our study findings suggest that HNSCC patients treated within 45days from diagnosis have increased survival probabilities and that early-stage patients suffered the most from treatment delay. Furthermore, care transition to specialized centers -though competitive to timely treatment- improves survival by providing the most innovative technologies and treatment approaches.
authors.affiliation: Unit of Cancer Epidemiology, CRO Aviano National Cancer Institute, via Gallini 2, 33081 Aviano (PN), Italy. Electronic address: polesel@cro.it.
authors.forename: Jerry
authors.initials: J
authors.lastname: Polesel
authors.affiliation: Unit of Radiotherapy, CRO Aviano National Cancer Institute, via Gallini 2, 33081 Aviano (PN), Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Furlan
authors.affiliation: Unit of Cancer Epidemiology, CRO Aviano National Cancer Institute, via Gallini 2, 33081 Aviano (PN), Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Birri
authors.affiliation: Unit of Otorhinolaryngology, Santa Maria degli Angeli General Hospital, via Montereale 24, 33170 Pordenone (PN), Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Giacomarra
authors.affiliation: Unit of Medical Oncology, CRO Aviano National Cancer Institute, via Gallini 2, 33081 Aviano (PN), Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Vaccher
authors.affiliation: Unit of Otorhinolaryngology, Santa Maria degli Angeli General Hospital, via Montereale 24, 33170 Pordenone (PN), Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Grando
authors.affiliation: Unit of Radiotherapy, CRO Aviano National Cancer Institute, via Gallini 2, 33081 Aviano (PN), Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Gobitti
authors.affiliation: Unit of Radiotherapy, CRO Aviano National Cancer Institute, via Gallini 2, 33081 Aviano (PN), Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Navarria
authors.affiliation: Unit of Medical Oncology, CRO Aviano National Cancer Institute, via Gallini 2, 33081 Aviano (PN), Italy.
authors.forename: Ornella
authors.initials: O
authors.lastname: Schioppa
authors.affiliation: Unit of Radiotherapy, CRO Aviano National Cancer Institute, via Gallini 2, 33081 Aviano (PN), Italy.
authors.forename: Emilio
authors.initials: E
authors.lastname: Minatel
authors.affiliation: Unit of Cancer Epidemiology, CRO Aviano National Cancer Institute, via Gallini 2, 33081 Aviano (PN), Italy.
authors.forename: Ettore
authors.initials: E
authors.lastname: Bidoli
authors.affiliation: Unit of Surgical Oncology, CRO Aviano National Cancer Institute, via Gallini 2, 33081 Aviano (PN), Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Barzan
authors.affiliation: Unit of Radiotherapy, CRO Aviano National Cancer Institute, via Gallini 2, 33081 Aviano (PN), Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Franchin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy*; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D000077195:Squamous Cell Carcinoma of Head and Neck; D016019:Survival Analysis; D055815:Young Adult
keywords: Head and neck cancer; Survival; Treatment delay