An observational study showed that prolonged postoperative and radiation intervals were associated with worse survival outcomes in patients with head and neck cancer (HNC) who underwent definitive surgery with a full course of radiation.1 The study findings were published in Cancer.

“Advances in subspecialty head and neck cancer care have led to increased complexities in execution,” the study authors wrote. “Multidisciplinary evaluation, modern surgical reconstruction, and sophisticated radiation planning have individually improved outcomes, but at the potential cost of lengthy delays.”

The aim of the study was to determine the collective impact of delays in diagnosis-to-treatment interval, postoperative interval, and radiation interval. Patients with HNC who completed definitive surgery with a full course of radiation between 2004 and 2013 were identified in the National Cancer Database. A total of 15,064 patients were included in the analysis.

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The researchers found that a longer postoperative interval (P < .001) and radiation interval (P < .001) were each correlated with worse survival. A prolonged diagnosis-to-treatment interval, however, was not. The effect of prolonged postoperative interval existed only during a window of 40 to 70 days after surgery (Hazard ratio [HR] = 1.14; 95% CI, 1.01-1.28; P = .029). The effect of the prolonged radiation interval increased continuously with each day of delay and leveled off at 55 days (HR = 1.25; 95% CI, 1.11-1.41; P < .001).

The study researchers also investigated postoperative and radiation intervals as a collective treatment package time. Survival was not impacted if treatment was completed within 84 days of surgery. However, only a small proportion of patients (16.7%) completed treatment within that time frame.

According to study authors, “minimizing treatment delay remains a formidable yet targetable area for improving the outcomes of patients with head and neck cancer.”


  1. Ho AS, Kim S, Tighiouart M, et al. Quantitative survival impact of composite treatment delays in head and neck cancer. Cancer. 2018;124(15):3154-3162.