Main Session
Sep
29
PQA 06 - Genitourinary Cancer, Gynecological Cancer, and Health Care Access and Engagement
3711 - Clinical and Access-Related Determinants of Curative-Intent Radiation Therapy Treatment Termination in Head and Neck Cancer
Presenter(s)
Kunika Chahal, MD, MPH - Northwell Health Cancer Institute, Lake Success, NY
K. Chahal1,2, Y. R. Wuu1,3, D. Myagmarsuren4, M. Akerman1,5, L. Potters1,6, and W. C. Chen1,7; 1Northwell, New Hyde Park, NY, 2SUNY Downstate College of Medicine, New York, NY, 3Department of Radiation Medicine, Northwell, New Hyde Park, NY, 4Virginia Tech Carilion School of Medicine, Roanoke, VA, 5Biostatistics Unit, Office of Academic Affairs, New Hyde Park, NY, 6Department of Radiation Medicine, Lenox Hill Hospital, New York, NY, 7Department of Radiation Medicine, South Shore University Hospital, Bay Shore, NY
Purpose/Objective(s):
Treatment termination (TT) during curative-intent radiation therapy (RT) for head and neck cancer (HNC) compromises oncologic outcomes and may reflect toxicity, vulnerability and barriers to care. We hypothesized that adverse clinical factors and access-related social determinants of health are associated with TT. This study aims to identify factors associated with TT to inform risk stratification, early intervention, and equitable treatment.Materials/Methods:
We conducted a retrospective cohort study of patients with HNC treated with curative-intent RT between 2015–2025 at a large academic health system. TT was defined as discontinuation of RT prior to completing the planned dose. A comparable control cohort of 100 patients who completed RT was selected. Sociodemographic variables evaluated include race, ethnicity, income, and travel burden. Clinical variables included age, baseline KPS, systemic therapy use, supportive care (dietician, speech/swallow, social work) utilization. Descriptive statistics were calculated and stratified by group. Univariate analyses were performed using chi-square or Fisher’s exact tests for categorical variables, and two sample t-tests or Mann-Whitney tests for continuous data. Patients receiving zero-fractions were excluded to distinguish barriers to treatment initiation versus discontinuation. Statistical significance was defined at p<0.05.Results:
Among 2,722 HNC patients, 186 experienced TT including 33 who received zero-fractions. Baseline KPS was lower among patients who terminated RT (80.1 vs 83.7 for completed treatment; p=0.003) and remained lower at treatment end (74.7 vs 78.3; p=0.017). Patients who completed treatment had significantly higher rates of speech/swallow evaluation (50.0% vs 29.6%; p<0.001) and dietician consultation (92.0% vs 70.4%; p<0.001). Social work utilization was similar between groups (63.0% vs 64.0%; p=0.87). Race was significantly associated with TT (p=0.007) with Asian patients exhibiting a lower rate of TT compared to White patients. Common reasons for TT included patient-assessed toxicity (38.7%), non-toxicity patient factors (25.8%), and hospice/death (22.0%). Estimated household income, travel (distance and time), age, concurrent chemotherapy use, and weight loss during treatment were not significantly associated with TT. Exclusion of zero-fraction patients confirmed stability of all findings, with no variables changing significance status.Conclusion:
TT in curative-intent HNC was influenced by both clinical vulnerability and differences in supportive care utilization, with toxicity as a leading cause. These findings support early integration of supportive services—particularly speech/swallow and dietician consultation—and targeted access interventions to improve treatment completion and promote equitable RT delivery.