Background
Methods
Subjects
Outcomes
Statistical analysis
Results
Nonstandard treatment (N = 142)* | |||
---|---|---|---|
Total population (N = 829) | Proposed by the MDT (N = 89) | Desired by the patient (N = 60) | |
Age (years) (mean and standard deviation) | 63.9 (11.1) | 67.2 (10.9) | 71.2 (12.2) |
Gender | |||
Male
| 596 (72 %) | 69 (78 %) | 32 (53 %) |
Female
| 233 (28 %) | 20 (22 %) | 28 (47 %) |
Comorbidity score (ACE-27) | |||
0
| 182 (22 %) | 3 (3 %) | 11 (18 %) |
1
| 327 (39 %) | 30 (34 %) | 18 (30 %) |
2
| 239 (29 %) | 36 (40 %) | 22 (37 %) |
3
| 81 (10 %) | 20 (23 %) | 9 (15 %) |
Tumor stage | |||
1
| 162 (20 %) | 5 (6 %) | 8 (13 %) |
2
| 180 (22 %) | 6 (7 %) | 7 (12 %) |
3
| 161 (19 %) | 26 (29 %) | 7 (12 %) |
4
| 326 (39 %) | 52 (58 %) | 38 (63 %) |
Tumor site | |||
Lip
| 24 (3 %) | 0 (0 %) | 1 (1 %) |
Nasopharynx
| 29 (4 %) | 4 (4 %) | 25 (42 %) |
Oral cavity
| 255 (31 %) | 17 (19 %) | 17 (29 %) |
Oropharynx
| 213 (26 %) | 27 (30 %) | 6 (10 %) |
Supraglottic larynx
| 89 (11 %) | 13 (15 %) | 3 (5 %) |
Glottic larynx
| 124 (15 %) | 8 (9 %) | 8 (13 %) |
Hypopharynx
| 95 (11 %) | 20 (23 %) | 0 (0 %) |
Prior malignancy | |||
No
| 669 (81 %) | 70 (79 %) | 47 (78 %) |
Other prior cancer yet treated
| 84 (10 %) | 7 (8 %) | 8 (13 %) |
Prior head and neck cancer yet treated
| 76 (9 %) | 12 (13 %) | 5 (9 %) |
Marital status | |||
Partner
| 569 (69 %) | 50 (56 %) | 27 (45 %) |
Single
| 260 (31 %) | 39 (44 %) | 33 (55 %) |
Standard treatment according to guidelines | |||
Radiotherapy
| 185 (22 %) | 10 (11 %) | 4 (7 %) |
Chemoradiation
| 183 (22 %) | 47 (53 %) | 14 (23 %) |
Surgery + radiotherapy
| 208 (25 %) | 20 (22 %) | 29 (48 %) |
Surgery + chemotherapy
| 12 (1 %) | 3 (3 %) | 0 (0 %) |
Surgery + postoperative radiation (PORT) on indication
| 116 (14 %) | 4 (5 %) | 7 (12 %) |
Surgery
| 125 (15 %) | 5 (6 %) | 6 (10 %) |
Year of treatment | |||
2010
| 234 (28 %) | 27 (30 %) | 21 (35 %) |
2011
| 259 (31 %) | 22 (25 %) | 21 (35 %) |
2012
| 335 (41 %) | 40 (45 %) | 18 (30 %) |
Characteristic |
OR unadjusted
| 95 % CI |
OR adjusted
b
| 95 % CI | |
---|---|---|---|---|---|
Age | <65 years a | 1.22 | 0.7–1.9 | 1.46 | 0.9–2.4 |
≥65 years | |||||
Gender | Male a | 0.72 | 0.4–1.2 | 0.72 | 0.4–1.3 |
Female | |||||
Comorbidity score (ACE-27) | Low (0–1) a | 3.06* | 1.9–4.8 | 3.40* | 2.0–5.7 |
High (2–3) | |||||
Tumor stage | Early (I-II) a | 5.74* | 3.0–11.0 | 3.40* | 1.4–8.5 |
Advanced (III-IV) | |||||
Tumor site | Oral cavity a | ||||
Pharynx | 2.75* | 1.6–4.9 | 0.94 | 0.4–2.2 | |
Larynx | 1.69 | 0.9–3.3 | 0.85 | 0.3–2.1 | |
Prior malignancy | No a | ||||
Other prior cancer yet treated | 0.78 | 0.3–1.6 | 0.61 | 0.3–1.5 | |
Prior head and neck cancer yet treated | 1.60 | 0.8–3.1 | 2.56* | 1.1–5.7 | |
Marital status | Partner a | 1.83* | 1.2–2.9 | 1.68 | 1.0–2.9 |
Single | |||||
Children | Yes a | ||||
No | 1.23 | 0.7–2.1 | 1.07 | 0.6–2.0 | |
Unknown | 0.79 | 0.4–1.5 | 1.31 | 0.7–2.7 | |
No contact | 0.84 | 0.7–1.1 | 0.90 | 0.7–1.1 | |
Standard treatment according to guidelines | Surgery a | ||||
Radiotherapy | 1.37 | 0.5–4.1 | 1.31 | 0.4–4.5 | |
Chemoradiation | 8.29* | 3.2–21.5 | 4.79* | 1.3–17.1 | |
Surgery + radiotherapy | 2.53 | 0.9–7.0 | 1.13 | 0.3–4.0 | |
Surgery + chemotherapy | 8.00* | 1.6–39.0 | 4.61 | 0.7–29.5 | |
Surgery + PORT on indication | 0.86 | 0.2–3.3 | 0.98 | 0.2–4.2 | |
Year of treatment | 2010 a | ||||
2011 | 0.71 | 0.4–1.3 | 0.56 | 0.3–1.1 | |
2012 | 1.04 | 0.6–1.7 | 1.11 | 0.6 2.0 |
Not stratified analysis | Stratification for gender | ||||||||
---|---|---|---|---|---|---|---|---|---|
Characteristic |
OR unadjusted
| 95 % CI |
OR adjusted
b
| 95 % CI |
♂OR adjusted
c
| 95 % CI |
♀OR adjusted
c
| 95 % CI | |
Age | <65 years a | 3.19* | 1.8–5.7 | 3.40* | 1.8–6.4 | 1.73 | 0.8–3.6 | 7.22* | 2.4–22.1 |
≥65 years | |||||||||
Gender | Male a | 2.41* | 1.4–4.1 | 2.66* | 1.5–4.8 | - | - | - | - |
Female | |||||||||
Comorbidity score (ACE-27) | Low (0–1) a | 1.78* | 1.0–3.0 | 1.49 | 0.8–2.7 | 1.77 | 0.8–3.7 | 1.39 | 0.6–3.3 |
High (2–3) | |||||||||
Tumor stage | Early (I-II) a | 2.22* | 1.2–4.1 | 1.07 | 0.4–2.9 | 2.88* | 1.2–7.1 | 1.92 | 0.8–4.7 |
Advanced (III-IV) | |||||||||
Tumor site | Oral cavity a | - | - | - | - | ||||
Pharynx | 0.78 | 0.4–1.4 | 1.34 | 0.6–3.0 | |||||
Larynx | 0.43* | 0.2–0.9 | 0.82 | 0.3–2.1 | |||||
Prior malignancy | No a | - | - | - | - | ||||
Other prior cancer yet treated | 1.39 | 0.6–3.1 | 1.09 | 0.5–2.6 | |||||
Prior head and neck cancer yet treated | 0.93 | 0.4–2.4 | 0.99 | 0.3–2.9 | |||||
Marital status | Partner a | 2.92* | 1.7–5.0 | 2.25* | 1.2–4.1 | 1.64 | 0.8–3.5 | 3.63* | 1.5–9.0 |
Single | |||||||||
Children | Yes a | - | - | - | - | ||||
No | 2.26* | 1.3–4.1 | 2.08* | 1.0–4.1 | |||||
Unknown | 0.78 | 0.3–1.8 | 1.19 | 0.5 3.0 | |||||
No contact | 1.66 | 0.4–7.5 | 1.19 | 0.2–5.9 | |||||
Standard treatment according to guidelines | Surgery a | - | - | - | - | ||||
Radiotherapy | 0.44 | 0.1–1.6 | 0.29 | 0.07–1.2 | |||||
Chemoradiation | 1.64 | 0.6–4.4 | 1.15 | 0.3–4.6 | |||||
Surgery + radiotherapy | 3.21* | 1.3–8.0 | 2.16 | 0.6–7.6 | |||||
Surgery + chemotherapy | - | - | - | - | |||||
Surgery + PORT on indication | 1.27 | 0.4–3.9 | 1.10 | 0.3–3.8 | |||||
Year of treatment | 2010 a | - | - | - | - | ||||
2011 | 0.89 | 0.5–1.7 | 0.73 | 0.4–1.5 | |||||
2012 | 0.57 | 0.3–1.1 | 0.63 | 0.3–1.3 |
Reported reasons of MDT members
| Number of cases | Percentage |
No surgery because of patient conditions | 18 | 20 % |
No chemotherapy because of patient conditions | 28 | 32 % |
No radiotherapy because of patient conditions | 6 | 7 % |
No treatment because of patient conditions | 5 | 6 % |
No radiotherapy because of medical history | 4 | 4 % |
Customized chemotherapy because of patient conditions | 20 | 22 % |
Customized radiotherapy because of patient conditions | 5 | 6 % |
Customized surgery because of patient conditions | 1 | 1 % |
Customized therapy because of patient conditions | 2 | 2 % |
Total
|
89
|
100 %
|
Reported reasons of patients
| Number of cases | Percentage |
Patient declines any treatment | 11 | 18 % |
Patient declines surgery | 19 | 32 % |
Patient declines radiotherapy | 12 | 20 % |
Patient declines chemotherapy | 4 | 7 % |
Patient cannot mentally handle therapy | 11 | 18 % |
Patient declines therapy because of GP recommendation | 2 | 3 % |
Patient declines therapy because of religious beliefs | 1 | 2 % |
Total
|
60
|
100 %
|