Impact of Delay in Treatment Initiation on Overall Survival in Laryngeal Cancers

Abstract

Objective Delayed treatment significantly affects survival in head and neck cancer, but defining delays for specific subsites remains controversial. The purpose of this study is to elicit the time point for delay in treatment initiation in all laryngeal cancers using a large cohort of patients within the National Cancer Database (NCDB). Study Design A retrospective cohort study. Setting NCDB. Subjects and Methods Patients with laryngeal cancer within the NCDB from 2006 to 2014 were identified. A recursive partition analysis (RPA) was performed to identify the time point at which delay contributed to increased hazard. Patients were stratified into 3 groups: no delay, at risk, and overtly delayed. Kaplan-Meier method was used to compare overall survival of these cohorts. Multivariate logistic regression analysis was used to identify predictors of delay. A multivariate Cox regression model was used to identify the final covariates that significantly affect overall survival. Results RPA identified the threshold for delay becomes significant at 46 days and exceeds baseline hazard at 73 days. Delay beyond 73 days is associated with a 16.1-month decrease in median survival ( P < .001). To ensure this was not due to any confounding variables, a subsequent Cox multivariate regression confirmed a significantly increased adjusted hazard ratio (HR) for patients who were at risk or delayed (adjusted HR [confidence interval], 1.09 [1.04-1.15] and 1.26 [1.18-1.35], respectively). Conclusion Treatment of laryngeal cancer requires a multidisciplinary approach, and coordinating this care can take time. Our study highlights that delay beyond 46 to 73 days significantly affects survival and identifies patients experiencing these delays.