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Compliance with posttreatment surveillance improves survival for head, neck cancers
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Patients with head and neck squamous cell carcinoma who complied with their posttreatment surveillance demonstrated improved survival, according to results of a retrospective cohort study.
Compliance with posttreatment surveillance was associated with smoking cessation and traveling less than 200 miles for follow-up, results also showed.
Michael W. Deutschmann, MD, FRCSC, head and neck surgery fellow at the University of Kansas Medical Center, and colleagues sought to determine whether compliance with posttreatment surveillance was associated with improved survival.
The researchers retrospectively followed a cohort of 332 patients with HNSCC who completed treatment and follow-up at the University of Kansas Medical Center between 2003 and 2008.
Mean follow-up was 45 months.
Most of the patients (74%) presented with advanced disease, and the most common primary site was the oral cavity (37%). Patients underwent surgery alone (20%), radiation alone (3%), surgery plus radiation (20%) or chemoradiation (26%).
Most patients (64%) did not develop disease recurrence.
Sixty percent of the patients lived within 50 miles of the treatment center, whereas 7% lived more than 200 miles away. Fifty-four percent of the patients lived in areas included in the U.S. Census Bureau tract middle income level.
Overall, 49% of all patients never missed a follow-up appointment. However, 30% of the patients were considered noncompliant because they missed three or more appointments during the surveillance period, and 20% of patients missed one or two appointments and were considered partially compliant.
Researchers noted there was no significant relation between compliance and treatment modality, sex, race, tumor stage, income level or age group; however, compliance was associated with tobacco cessation (P = .003) and distance from the medical center (P = .008).
Survival was associated with posttreatment surveillance compliance (P = .001), U.S. Census tract income level (P = .001) and the distance traveled to the follow-up treatment center (P = .01). Although posttreatment compliance influenced survival as a whole, the differences in the risk for death did not statistically differ between the different levels of compliance. Patients who were partially compliant demonstrated the lowest odds for death (HR = 0.71; 95% CI, 0.45-1.1).
Results of a multivariable analysis indicated advanced stage at presentation (HR = 1.76; 95% CI, 1.21-2.58), middle census tract income level (HR = 1.64; 95% CI, 1.13-2.39), moderate census tract income level (HR = 1.9; 95% CI, 1.18-3.06) and age at diagnosis (HR = 1.03; 95% CI, 1.01-1.04) were significantly associated with an increased risk for death.
Deutschmann and colleagues said they were unable to determine the reason for the loss of follow-up for some patients, who may have followed up with other clinicians closer to their homes. Another limitation was the lack of data on HPV status for patients with oropharyngeal squamous cell carcinoma. Since routine testing for HPV was not standard during the period examined, the researchers were unable to determine the effect of HPV status on the cohort.
“The nature of the study introduces a selection bias that is impossible to control,” Deutschmann and colleagues wrote. “Given the multiple variables influencing survival, it is not surprising when these variables are associated with one another.
“However, our hazard model shows that age, compliance with posttreatment surveillance, advanced stage and census tract income levels all independently affect survival in this patient cohort. We believe this patient cohort is a typical representation of the population with head and neck cancer, both in demographics and compliance, and the results are widely applicable to this general population.” – by Anthony SanFilippo
Disclosure: The researchers report no relevant financial disclosures.
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