The impact of national holidays on postoperative radiotherapy of squamous cell carcinoma of the head and neck.
Michael S Kim, Margaret Sheridan, Murali Rajaraman, Helmut Hollenhorst, Amanda Caissie, Ashraf Mahmoud-Ahmed, Nathan Lamond, Stephanie Snow, Martin Corsten, S Mark Taylor, Jonathan R B Trites, Matthew H Rigby, Martin Bullock, Derek Wilke
Author Information
Michael S Kim: Department of Radiation Oncology, Nova Scotia Cancer Centre, Dalhousie University, Halifax, Canada.
Margaret Sheridan: Division of Medical Oncology - Department of Medicine, Dalhousie University, Halifax, Canada.
Murali Rajaraman: Department of Radiation Oncology, Nova Scotia Cancer Centre, Dalhousie University, Halifax, Canada.
Helmut Hollenhorst: Department of Radiation Oncology, Nova Scotia Cancer Centre, Dalhousie University, Halifax, Canada.
Amanda Caissie: Department of Radiation Oncology, Nova Scotia Cancer Centre, Dalhousie University, Halifax, Canada.
Ashraf Mahmoud-Ahmed: Department of Radiation Oncology, Cape Breton Cancer Centre, Dalhousie University, Halifax, Canada.
Nathan Lamond: Division of Medical Oncology - Department of Medicine, Dalhousie University, Halifax, Canada.
Stephanie Snow: Division of Medical Oncology - Department of Medicine, Dalhousie University, Halifax, Canada.
Martin Corsten: Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, Halifax, Canada.
S Mark Taylor: Department of Pathology, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada.
Jonathan R B Trites: Department of Pathology, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada.
Matthew H Rigby: Department of Pathology, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada.
Martin Bullock: Department of Pathology, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada.
Derek Wilke: Department of Radiation Oncology, Nova Scotia Cancer Centre, Dalhousie University, Halifax, Canada.
Background: Delays in starting postoperative radiotherapy (PORT) have been established as negative predictors for clinical outcomes in head and neck squamous cell carcinomas (HNSCC). Our study aimed to examine the effect of delays during PORT, and the impact of national holidays in Canada, a publicly funded system, on oncologic outcomes such as Overall Survival (OS) and Local Recurrence (LR). Methods: The provincial cancer registry was queried to obtain demographic, pathologic, and outcomes data from cancer patients treated for all squamous cell carcinomas of the head and neck region treated between January 1, 2007 and November 30, 2019. All extracted information was cross-referenced and supplemented by chart review of patient electronic medical records. Extracted data were analyzed for OS and LR, in the context of Canadian national holidays causing delays during PORT. Results: 1433 patients treated for HNSCCs were identified, of whom 338 were treated curatively with surgery followed by PORT. 68.6% of patients experienced at least one day of interruption during treatments due to holidays. LR was 15.4% and OS was 59.6% at 5 years. Treatment interruptions by holidays were predictive of local recurrence (HR, 2.38; 95% CI 1.17-4.83; p = 0.017). Patients that developed early recurrence prior to PORT had very poor oncologic outcomes. Conclusion: Our findings were consistent with previously published studies in limiting the interval between surgery and PORT. We identified the novel finding of paired holidays as a significant predictor in determining LR, suggesting the importance of modifying RT delivery schedules and timing.
