More than 65,000 Americans are diagnosed annually with head and neck cancer, which most often occurs inside the mouth and throat. For patients who undergo surgery to treat this cancer, guidelines recommend that prompt initiation of radiotherapy -- within six weeks -- is critical for best outcomes.
Unfortunately, delays in initiating post-operative radiotherapy (PORT) are far too common. Patients do not always understand the importance of prompt initiation of radiotherapy and may have to overcome other barriers, such as lack of social support and insurance. In addition, health care providers do not always communicate with one another or coordinate care. These avoidable delays have a negative impact on outcomes in a disease that claims almost 15,000 lives in the U.S. each year.
To ameliorate this crisis, a research team at the Medical University of South Carolina has developed and validated tools known as nomograms to help predict treatment delays in high-risk patients based on individualized risk factors. The team was led by Evan Graboyes, M.D., an assistant professor in the Department of Otolaryngology-Head & Neck Surgery at MUSC and a member of the Cancer Control Program at Hollings Cancer Center. The results of the nomogram study were reported in JAMA Otolaryngology-Head & Neck Surgery.
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"A nomogram is a graphical representation of a mathematical model that we are using to predict how likely it is that a patient with head and neck cancer may have a treatment delay," explained Graboyes. "We hope that these nomograms can be used to identify patients at highest risk for treatment delays so that we can target interventions to them to decrease the risk of delay."
Standard-of-care treatment for patients with head and neck cancer combines surgery, radiation and chemotherapy. However, treatment outcomes remain very poor, and only about 50% of head and neck cancer patients with advanced disease will survive after 5 years.
With the goal of improving the survival rate of patients with head and neck cancer, Graboyes and his team developed and validated two types of nomograms for predicting delays in PORT. The study examined pre- and post-surgical data from 60,766 adult patients with head and neck cancer, grouped into different cohorts.
The first nomogram is based on information available to both the clinician and patient during the surgical consultation. At this point, the patient will know whether he or she is likely going to have surgery followed by radiation therapy.
