Poor Compliance With Radiotherapy Was Associated With Worse Survival Outcome in Patients With Head and Neck Cancer

Compliance with radiotherapy (RT) is associated with therapeutic efficacy and long-term prognosis in patients with head and neck squamous cell carcinoma (HNSCC).

The study aims to measure the association between compliance with RT and 5-year overall survival (OS).

This was a prospective cohort study conducted at Kaohsiung Veterans General Hospital. The study population consisted of patients diagnosed with HNSCC who were candidates for curative or postoperative RT or concurrent chemoradiotherapy. Exclusion criteria included patients who did not receive radiation therapy, duplicate cases, or those with incomplete behavioral economics-based questionnaire data.

The predictor variable was compliance with RT. Compliance was defined as completing the prescribed RT/chemoradiotherapy protocol with ≤ 5 days of treatment interruption and was coded as yes or no.

The primary outcome variable was 5-year OS, measured from the date of the last treatment session to the date of last follow-up or death.

Covariates included demographic data, tumor-specific factors, treatment modalities, risk perception thresholds assessed via behavioral economics questionnaires, and patient insurance status.

Poisson regression analysis and Cox regression models were used to identify factors influencing compliance and OS. Statistical software was used with significance set at a two-tailed P value of ≤ .05.

The sample was composed of 126 subjects (mean age 53.1 ± 9.4 years; 84.1% male). Overall compliance was estimated at 77.0%. Compliance was significantly associated with 5-year OS (hazard ratio, 3.72; 95% confidence interval [CI], 1.61 to 8.60; P = .002), with an estimated 5-year OS of 85.0% for the compliant group versus 56.8% for the noncompliant group. Factors associated with compliance included the presence of private insurance (RR, 2.25; 95% CI, 1.21 to 4.17; P = .011) and risk perception thresholds (RR, 2.07; 95% CI, 1.86 to 4.98; P = .041).

Treatment compliance is statistically significantly associated with survival in HNSCC. Early identification of financial fragility and risk tolerance thresholds can help health care teams recognize high-risk patients and provide personalized support to enhance clinical outcomes.