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).