"This type of nomogram will provide a personalized estimate of the risk of delay commencing PORT and can be used to enhance counseling and guide interventions for patients with higher risks of delay," explained Graboyes.
The findings of Graboyes' study suggest that stage 4 cancer and oral cavity sites are two of the main variables associated with delayed PORT initiation. Knowing this type of information beforehand will enable patients to obtain pre-surgical dental oncologic treatment referrals and may greatly improve timely PORT introduction.
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The second nomogram incorporates information from before and after surgery. According to Graboyes, this nomogram can be used by health care systems to compare their rates of PORT delay in a risk-adjusted fashion that acknowledges differences in the types of patients being treated.
In addition, the nomogram may guide quality improvement initiatives. For example, one of the key factors associated with delayed PORT was prolonged length of stay after surgery. This information may help physicians to reduce the length of time patients stay in the hospital after surgery, eliminating one hurdle to prompt initiation of radiation treatment.
Although the two nomograms were developed in one cohort of patients and validated in a second cohort of patients with head and neck cancer from across the U.S., the study still had some key limitations. The nomogram didn't account for individual patient education, income, social support, dental disease, smoking or alcohol consumption. Therefore, more research will be needed to understand the degree to which these factors lead to delays in PORT initiation. A future study will help to address some of these limitations.
Graboyes believes that the current study will help head and neck cancer patients get the treatment they need and improve their chance of survival.
"I would love it if patients and clinicians would be able to use the nomogram website to get more precise, quantitative information about the risk of PORT delay and use it to educate patients, counsel them before treatment and communicate risk precisely," said Graboyes. "We know that getting patients timely head and neck cancer care that follows guidelines is a promising strategy to improve survival among these patients. I hope these nomograms will be a practical and useful tool as we work toward the goal of decreasing treatment delays."
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