Medicare recipients with head and neck cancer often fail to complete their radiation therapy, according to a report in the September issue of Archives of Otolaryngology—Head and Neck Surgery.
According to Megan Dann Fesinmeyer, PhD, of the Fred Hutchinson Cancer Research Center in Seattle and colleagues, patients who have surgery before radiation treatment appear more likely to complete therapy, while those who have other illnesses or who have chemotherapy first are more likely to interrupt their radiation treatments or discontinue them entirely.
This can significantly affect the treatment result. According to the authors, “Clinical evidence suggests that the radiation dose and duration of treatment is correlated with tumor control and survival. Breaks in radiotherapy have been associated with inferior tumor control in the larynx, pharynx and oral cavity.”
The authors used cancer registries linked to Medicare data to identify 5,086 neck and head cancer patients diagnosed between 1997 and 2003. Then, using that data, they calculated the timing and duration of radiotherapy and performed analyses to estimate the association between tumor and clinical characteristics and interruptions or discontinuation of therapy.
Almost 40 (39.8) percent of patients had interruptions in treatment or failed to complete their course of radiation therapy.
Patients who had surgery at any tumor site were more likely to complete radiotherapy with no interruptions (70.4 percent as opposed to 52 percent of those who didn’t have surgery.) Patients undergoing chemotherapy, whose disease had spread to surrounding lymph nodes, or had concurring illnesses, were less likely to interrupt or stop radiotherapy.
“Surgical patients may be more likely to complete radiotherapy for several reasons,” wrote the authors, “First, characteristics that make patients good candidates for surgery may also make them more likely to complete radiotherapy. Because comorbidities are known to decrease survival in patients with head and neck cancer, healthier patients may be chosen by surgeons to complete more rigorous treatments (e.g., surgery in addition to radiotherapy). In addition, patients who are willing to undergo major surgery to treat their disease may also be more motivated to complete a full course of uninterrupted radiation therapy, despite any toxic effects of treatment that may occur.”