(611) Current Trends in Time to Treatment Initiation in Head and Neck Squamous Cell Carcinoma

Introduction: Increase in time to treatment initiation (TTI) between 1998 and 2011 has been reported in patients diagnosed with head and neck squamous cell carcinoma (HNSCC). Additionally, timeliness to treatment is a critical determinant of survival outcomes for patients with HNSCC across all treatment modalities. However, trends in TTI among patients with HNSCC have not been thoroughly investigated in over a decade.

Methods: The National Cancer Data Base (NCDB) was queried to identify patients with HNSCC for the years from 2011 to 2019 in the United States. Primary outcome was time to treatment initiation (TTI) as defined as number of days from diagnosis to initiation of definitive treatment. Independent variables included age, race, insurance type, facility type, distance from treatment facility, zip code level education, zip code level income, staging, Charlson comorbidity score, and treatment type. Patients with metastatic disease at time of presentation, those who received therapy for palliative intent, and those who initiated treatment >365 days after the diagnosis date were excluded from the study. Multivariable analyses were performed on data after 2011 using a Poisson generalized linear model with log link function.

Results: In total, 272,252 patients were included. Median TTI increased yearly from 28 to 34 days between 2011 and 2019. Multivariable analysis revealed a 18.7% (95% CI 16.7%-20.9%, p < 0.001) increase in TTI from 2011 to 2019. Non-white race, lack of insurance, academic facility, increased distance from facility, zip codes with low education level, increased staging, and increased Charlson comorbidity score were all significantly associated with increased TTI.

Conclusions: A concerning trend of increasing TTI for patients with HNSCC was first reported in 2011. Since it was first identified, the trend of increasing TTI has only continued. Further research into the cause of this trend is necessary in order to identify how it can be addressed.