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Delayed diagnosis to treatment interval (DTI) in head & neck cancers - A systematic review and meta-analysis
Noémie Villemure-Poliquin1, Rui Fu1, Karolina Gaebe2
1Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada.
Introduction:
Delayed diagnosis to treatment interval (DTI) in head and neck cancers (HNC) can significantly impact patient outcomes. The need for multimodal treatment in HNC may cause delays in initiation of treatment. This systematic review aims to provide a comprehensive understanding of the consequences of delayed DTI on both oncologic and QoL outcomes, proposing a new quality benchmark along the treatment continuum of HNC patients.
Methods:
We searched MEDLINE, Embase, CENTRAL, Web of Science, and CINAHL databases for trials and cohort studies evaluating the impact of delayed DTI in patients with HNC. Outcomes included overall survival (OS), disease-free survival (DFS), locoregional (LRR) and local recurrences (LR) and distant metastasis.
Results:
Our search strategy initially identified 10,779 titles and abstracts, of which 63 articles met inclusion criteria for a total of 873,718 patients. The pooled analysis showed that treatment initiation within 30 days improved OS by 9 % compared to longer intervals (aHR: 1.09 [1.06-1.13]; I2 = 80 %), with no significant associations found for DFS, LRR, LR, or distant metastasis.
Conclusion:
While adherence to a 30-day DTI may be associated with improved survival in some HNC patients, significant heterogeneity in the data limits the generalizability of this finding. Further research with more refined analyses, including adjustments for treatment modality and cancer stage, is necessary. Additionally, gaps remain in the literature, particularly in the methodological limitations related to DTI classification.
