The impact of national holidays on postoperative radiotherapy of squamous cell carcinoma of the head and neck

• Published in: Clinical and translational radiation oncology 2023-09, Vol.42, p.100668-100668, Article 100668
• Main Authors: Kim, Michael S., Sheridan, Margaret, Rajaraman, Murali, Hollenhorst, Helmut, Caissie, Amanda, Mahmoud-Ahmed, Ashraf, Lamond, Nathan, Snow, Stephanie, Corsten, Martin, Mark Taylor, S., Trites, Jonathan R.B., Rigby, Matthew H., Bullock, Martin, Wilke, Derek
• Format: Article
• Language: English
• Subjects: Accelerated radiotherapy; Clinical oncology; Head and neck cancer; Original; Public health systems; Radiotherapy; Resource management
• ISSN: 2405-6308; 2405-6308
• DOI: 10.1016/j.ctro.2023.100668

BackgroundDelays in starting postoperative radiotherapy (PORT) have been established as negative predictors for clinical outcomes in head and neck squamous cell carcinomas (HNSCC). Our study aimed to examine the effect of delays during PORT, and the impact of national holidays in Canada, a publicly funded system, on oncologic outcomes such as Overall Survival (OS) and Local Recurrence (LR). MethodsThe provincial cancer registry was queried to obtain demographic, pathologic, and outcomes data from cancer patients treated for all squamous cell carcinomas of the head and neck region treated between January 1, 2007 and November 30, 2019. All extracted information was cross-referenced and supplemented by chart review of patient electronic medical records. Extracted data were analyzed for OS and LR, in the context of Canadian national holidays causing delays during PORT. Results1433 patients treated for HNSCCs were identified, of whom 338 were treated curatively with surgery followed by PORT. 68.6% of patients experienced at least one day of interruption during treatments due to holidays. LR was 15.4% and OS was 59.6% at 5 years. Treatment interruptions by holidays were predictive of local recurrence (HR, 2.38; 95% CI 1.17-4.83; p = 0.017). Patients that developed early recurrence prior to PORT had very poor oncologic outcomes. ConclusionOur findings were consistent with previously published studies in limiting the interval between surgery and PORT. We identified the novel finding of paired holidays as a significant predictor in determining LR, suggesting the importance of modifying RT delivery schedules and timing.