3204 - Factors Influencing Treatment Termination in Head and Neck Cancer: Insights from a 10-Year Analysis
Presenter(s)
K. Chahal1, Y. R. Wuu2,3, D. Myagmarsuren4, M. Akerman2,5, B. Gui2,3, L. Potters2,6, and W. C. Chen2,7; 1SUNY Downstate College of Medicine, New York, NY, 2Northwell, New Hyde Park, 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, Bayshore, NY
Purpose/Objective(s):
Patients with head and neck cancer (HNC) undergoing curative or palliative radiation therapy (RT) often experience barriers to treatment completion, including RT-related toxicity, comorbidities, and discontinuation against medical advice. Early treatment termination (TT) or unplanned RT interruptions are associated with decreased overall survival (OS). This study examined factors associated with TT in HNC patients.
Materials/Methods:
We conducted a retrospective analysis of HNC patients who had a TT between 2015-2024. Sociodemographic, clinical data, supportive care utilization, and treatment intent (curative vs. palliative) were analyzed with respect to TT reasons: toxicity- or non-toxicity-related (patient or clinician choice), hospice/death, disease progression, or COVID-19. Chi-square or Fisher's exact tests were used to analyze categorical variables, and ANOVA or Kruskal-Wallis tests were used for continuous data. The Cochran-Armitage trend test assessed temporal trends in TT and supportive care use.
Results:
Out of 39,677 patients, 2,722 (6.8%) were treated for HNC between 2015-2024. Among these, 217 (8.0%) had a TT, and 186 (86%) were treated with curative intent. The most common subsites were oropharynx (n=46), oral cavity (n=45), larynx (n=29), and skin (n=24). Significant differences (p<0.05) between the curative and palliative treatment groups were observed for TT reasons, initiation of RT, chemotherapy and immunotherapy use, and utilization of speech/swallow and dietary support services. Among curative-intent patients, 22.0% died or entered hospice care compared to 64.5% of those receiving palliative RT. Notably, 45.2% of palliative patients did not initiate RT. From 2015-2024, the use of supportive services (speech/swallow therapy, dietician support, social work) increased significantly (p=0.03, 0.008, and 0.03, respectively), rising from 17.4%-43.5% in 2015 to 50.0%-64.3% in 2024. Concurrently, TT rates decreased from 10% in 2015 to 5% in 2024 (p=0.0009).
Conclusion:
Identifying factors associated with TT is crucial for improving patient outcomes. Further analysis focused on differences between curative and palliative patients is needed to address barriers to treatment adherence, thereby improving quality of life and OS. Strategies to optimize supportive care services, communication, and management of treatment-related toxicities may reduce TT rates and enhance the quality of patient care.
Abstract 3204 - Table 1
P = Patient, C = Clinician
| Curative (n=186) | Palliative (n = 31) | p-value | |
| TT reason | <0.001 | ||
| Toxicity - P | 72 (38.7%) | 1 (3.2%) | |
| Nontoxicity - P | 48 (25.8%) | 4 (12.9%) | |
| Toxicity - C | 8 (4.3%) | 4 (12.9%) | |
| Nontoxicity - C | 5 (2.7%) | 1 (3.2%) | |
| Hospice/Expired | 41 (22.0%) | 20 (64.5%) | |
| COVID-19 | 2 (1.1%) | 0 (0.0%) | |
| Disease Progression | 10 (5.4%) | 1 (3.2%) | |
| Zero fraction | 33 (17.7%) | 14 (45.2%) | <0.001 |
| Chemotherapy | 108 (58.1%) | 12 (38.7%) | 0.045 |
| Immunotherapy | 29 (15.6%) | 10 (32.3%) | 0.025 |
| Speech/swallow | 55 (29.6%) | 3 (9.7%) | 0.020 |
| Dietician | 131 (70.4%) | 12 (38.7%) | <0.001 |