Optimizing Diagnostic Workup Leads to Reduction in Time-to-Treatment Interval for HNC

The implementation of a fast-track, multidisciplinary, integrated care program titled “optimized workup” as a diagnostic workup in patients with head and neck cancer (HNC) led to a significant reduction in the time-to-treatment interval, according to a study published in Cancer.

In addition, overall survival and patient satisfaction increased significantly with the use of the program, while costs did not change.

“Time-to-treatment intervals are particularly important for patients with HNC because, as mentioned before, these tumors are relatively fast growing in an anatomically and functionally complex and delicate area,” the authors explained.

Using all patients with newly diagnosed HNC who underwent staging and treatment at the Radboud University Medical Center, researchers compared the use of conventional workup (CW; implemented in 2009) to the use of optimized workup (OW; implemented in 2014). The study consisted of 486 patients with HNC, including 218 who underwent CW and 268 who underwent OW.

Overall, the time-to-treatment interval was significantly lower in the OW cohort than the CW cohort (21 vs 34 days; P < .0001). Moreover, the 3-year overall survival rate was 12% higher after OW (72% in the CW cohort vs 84% in the OW cohort; P = .002). Following correction for confounders, the 3-year risk of death remained significantly lower in the OW cohort (hazard ratio, 1.73; 95% confidence interval, 1.14-2.63; P = .010).

“In addition to reduced time-to-treatment intervals, the systematic integration of upfront geriatric assessment for elderly patients and screening by dentists, dental hygienists, dieticians, and speech and swallow therapists also contributes to the improvement of quality of care and is also likely to have played a role in determining survival outcomes,” the authors noted.

Between the 2 cohorts, total diagnostic costs were comparable. However, the general satisfaction score, as measured with the Consumer Quality Index for Oncological Care, was significantly better in a matched OW group than the CW group (9.1 vs 8.5; P = .007).

“Diagnostic costs are, however, just a fraction of the costs of treatment,” the authors wrote. “Although we did not study this in our cohorts, it is likely that disease progression caused by prolonged diagnostic and therapeutic intervals will result in a higher number of cases that need additional treatment or even revision of the treatment plan in some cases.”

The researchers indicated that an important limitation of the study is its retrospective nature. Specifically, complex cases will have prolonged time-to-treatment intervals. Although investigators did correct for stage and comorbidity, it remains unclear whether these factors still affected overall survival, especially in patients with a specialist-to-treatment delay longer than 30 days.

“In conclusion, after the implementation of a fast-track, multidisciplinary, integrated care program, the interval from the first consultation to the start of treatment was considerably shortened, overall survival significantly improved, patient satisfaction increased, and costs remained the same,” the authors wrote. “Optimizing the diagnostic track and quality of care results in better oncological outcomes without increases in toxicity or costs.”

Reference:

Schutte HW, van den Broek GB, Steen SCA, et al. Impact of Optimizing Diagnostic Workup and Reducing the Time to Treatment in Head and Neck Cancer. Cancer. doi: 10.1002/cncr.33037.