Abstract
OBJECTIVE: The objective of this study was to determine the rate at which veterans with head and neck squamous cell carcinoma (HNSCC) received care adhering to National Comprehensive Care Network (NCCN) guidelines for postoperative radiation and to identify factors associated with non-adherence. The guidelines recommend initiation of postoperative radiation therapy (PORT) within 6 weeks of surgery. STUDY DESIGN: This was a retrospective cohort analysis of a pre-existing database. SETTING: This study, performed at the DC Veterans Affairs Medical Center, identified patients with HNSCC who underwent surgery with curative intent followed by adjuvant radiation ± chemotherapy between 1991 and 2021. METHODS: Variables assessed included patient demographics, cancer stage and site, treatment type, dates of treatment initiation and completion, and adherence to the NCCN guidelines for PORT initiation. Fisher exact test was used to identify factors associated with delays >6 weeks. RESULTS: Among the 132 veterans identified, 72 (54.5%) underwent surgery followed by adjuvant PORT. Only 18 veterans (25%) started radiation within 6 weeks of surgery. Patients who underwent a neck dissection at the time of the index surgery (P = .028), dental extraction (P = .032), or gastrostomy tube placement (P = .041) were more likely to experience delays. CONCLUSION: Only 25% of veterans initiated PORT within 6 weeks. Identifying causes of delays provides an important step in addressing discrepancies between guideline-directed care and actual care delivered. Development of efficient care pathways to increase guideline-congruent initiation of PORT should be considered.