Delayed Treatment Initiation in the Head and Neck Cancer Care Trajectory

Patients with cancer in the head and neck region (HNC) often need a combination of treatment techniques (i.e. radiotherapy with chemotherapy or surgery followed by irradiation). If HNC is suspected, additional investigations, such as scanning and biopsy are performed. After this, an individual treatment plan is set up, taking into account the patient’s general health and wishes. This process is called the care pathway.
The longer the interval between symptoms and start of treatment, the further the tumor can grow and spread. Patients with larger tumors have a higher change of worse outcome (regarding permanent disabilities and survival).
Therefore, it is important to perform relevant investigations while minimizing delay before start of treatment.
This thesis focuses on 1) investigating factors contributing to delay before start of treatment in HNC and 2) analyzing the possible effects of delay.

Only the minority of patients started treatment within the recommended 30 days. Factors associated with delay were larger tumor size and treatment with radiation. Vulnerable patients did not have increased risk of delay.
Patients with a longer care pathway had a longer hospital admission and risk of return of the cancer, but did not have higher chance of dying, or lower quality of life.

Delaying start of treatment for logistic reasons should be avoided for all patients. Nonetheless, the effect of delay on outcome is relatively small. In certain cases, the benefits of taking time for shared decision-making and optimization of the patient before treatment may outweigh the potential consequences of delaying treatment initiation.