Impact of age, comorbidity, and WHO performance status on delay of treatment in patients undergoing fast-track work-up for head and neck cancer.

Abstract

OBJECTIVES: Fast-track programs for diagnostic work-up and start of cancer treatment are defined by legislation in Denmark. The aim was to examine whether age, comorbidity or WHO performance status influence the time from referral due to suspicion of cancer to start of treatment (waiting time) in the Danish fast-track program.

MATERIAL AND METHODS: For this descriptive cohort study, consecutive head and neck cancer (HNC) patients who underwent radiotherapy or surgery from January 2014 to July 2016 at Odense University Hospital (OUH) were identified in the database of the Danish Head and Neck Cancer group (DAHANCA). Age (<70 vs. ≥70 years), comorbidity (none vs. any), and WHO performance status (0-1 vs. 2-4) were correlated to waiting time.

RESULTS: In total, 650 HNC-patients were included and of those, 92% were discussed at the multidisciplinary team conference. Patients ≥70 years were less frequently discussed in a multidisciplinary setting compared to younger patients (88% vs. 93%, p < 0.05). The time spent for diagnostic workup and treatment planning (waiting time) was longer for patients having primary radiotherapy than for primary surgery (p < 0.001), and 21% of patients treated with primary radiation exceeded the recommended maximum waiting time, whereas this was the case for only 7% of the patients treated with primary surgery. However, age ≥ 70 years, presence of comorbidity or poor performance status did not significantly influence the waiting time.

CONCLUSION: Age ≥ 70 years, comorbidity and poor WHO performance status did not influence the waiting time among patients with head and neck cancer treated at OUH.