Timing is everything in treating head & neck cancers and every day counts, whether it is the time from symptom development to diagnosis, from diagnosis to initiation of radiation treatment, or from start date of radiotherapy to completion of radiation treatment. Radiation treatment either alone or in combination with chemotherapy plays a pivotal role in the management of head and neck cancers.
By avoiding the delays in diagnosis to final execution of radiation therapy, we can increase the control rate and survival for these patients. There is sufficient evidence to prove that tumor burden is increased and prognosis is worsened by increasing the time to initiate treatment. Unfortunately, this effect is more pronounced in patients with an early stage cancer because of nodal disease upstaging during the waiting days.
对健康成果和成本的影响
Prognosis is worsened by increasing the time to initiate treatment
Prolonged radiation treatment time is associated with worse survival in patients receiving radiation therapy for HNC, even in the setting of combining chemotherapy with radiation. Prolonged time to treatment initiation (TTI) of greater than 46 to 52 days is independently associated with worse mortality (Figure 1).
在荷兰的一项研究中，通过在局部麻醉下进行活检，而不是全身麻醉，并将CT和PET扫描结合起来，以减少HNC患者的等待时间从5到22天，以诊断和放射治疗的目的，质量调整后的寿命- 年龄从0.13增加到0.66。当将个人净货币福利推送到组织和国家一级时，观察到医疗保健付款人分别受益1410万欧元和9150万欧元，从而降低了整体成本。
较短治疗时间的障碍
Several factors are implicated in delaying treatment initiation that can be either healthcare system associated, or patient-related. Healthcare related factors include advancement in diagnostic modalities, transfer of patient to academic healthcare centers accompanied by delayed referrals and long-awaited appointments, advancement in radiation treatment modalities (Intensity modulated radiation treatment takes longer than conventional 3-D planning), treatment with concurrent chemoradiation and delay in diagnosis and referral.
与患者有关的方面包括癌症的阶段，报告时间和社会经济因素的延迟。与社区计划（22至23天）相比，学术机构的中位数为中位数（28天），这可能是由于患者过渡护理，这是较高TTI的独立因素。然而，尽管中位TTI中位数较高，但与社区医院相比，学术机构与护理过渡相比，总体生存的改善相关。
Strategies to improve delays in treatment times
提供next-day appointments with cancer specialists is an appropriate step
有一些方法可以改善辐射治疗启动，执行和完成的延迟。存在一个范式来缩短TTI；当丹麦卫生系统报告的头颈癌的TTI大于美国的TTI时，引入了一种捆绑的多学科诊断，评估和治疗方法。这样的事业需要在提供者之间进行相当大的协调，并要求为具有新癌症诊断的患者加快任命。有效的护理过渡以及癌症护理方式到社区医疗保健中心不仅可以改善次要医疗保健中心的护理质量，而且还有助于减轻高等教育中心的患者负担。
A quick and well-structured multidisciplinary appointment program is fundamental in shortening the time required for patient referrals, thus increasing the optimal survival time for HNC patients with early initiation of treatment. Recently piloted programs offering next-day appointments with cancer specialists is an appropriate step to address this reversible predictor of mortality and may partially alleviate increasing waiting times.
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