Results
302 patients were identified. Patients were excluded for the following
reasons: no adjuvant therapy recommended (n=140), declined
post-operative therapy (n=23), patient died before adjuvant therapy
could begin (n=7), additional therapy was palliative and/or the patient
moved in to hospice care (n=5), and lost to follow up (n=3). 124
patients met inclusion criteria (Table 1). The patient demographic
information is presented in Table 1. Most patients were >50
years old, male, white, and smokers. There were a variety of payer
types, with the highest proportion being privately insured (44.4%).
The median number of days from surgery to initiation of PORT in these
patients was 55.5 days (7.9 weeks). 11.4% of patients began PORT within
42 days or fewer.
Statistically significant factors for increased interval from surgery to
initiation of adjuvant therapy include post-op length of stay greater
than or equal to eight days (p = 0.01, mean difference of 6.9, (95% CI
of -0.9, 14.8 days)), readmission within 30-days of surgery (p = 0.045,
mean 13.1, (0.9, 25.4), no adjuvant chemotherapy post-operatively (p =
0.0087, mean 7.9 (0.1, 15.7), post-operative complications (p = 0.011,
mean 7.1 (-0.8, 15.1), and fragmented care (p = 0.018, mean 11.4, (4.4,
18.4).
Figures 1 through 4 depict the proportion of patients who initiated
adjuvant therapy over time for selected risk factors. Figure 1 depicts
the delays in initiation of therapy in association with fragmented care.
For those receiving fragmented care, a greater proportion of patients
had not yet started therapy as the post-operative date increased. Figure
2 depicts the delay demonstrates the delays in post-operative radiation
therapy associated with increased hospital length of stay after surgery.
Figure 3 depicts the delays in initiation of therapy in association with
concurrent therapy. For patients receiving adjuvant chemotherapy, a
greater proportion of patients had initiated therapy as the
post-operative date increased.
Admission to a rehabilitation center after surgery, the need for dental
extractions, and the need for a feeding tube placement showed a delay in
initiation, but were not statistically significant. Tumor pathology and
primary site did not show a statistically significant delay to
initiation of treatment (Table 2).