Patient Compliance to Radiation for Advanced Head and Neck Cancer at a Tertiary Care County Hospital

Background: Combined chemotherapy and radiotherapy are routinely used to treat advanced-stage head and neck squamous cell carcinoma (HNSCC). Patient compliance is often difficult given increased toxicities. Medically underserved or uninsured patients may lack the necessary support to complete such treatment. Objective: To evaluate compliance to radiation therapy for patients with advanced stage HNSCC at an urban tertiary-care county hospital. Study Design: Retrospective review. Methods: Data were extracted from the charts of 136 consecutive patients who had been advised to undergo chemoradiotherapy for newly diagnosed HNSCC from 2004 to 2006. Demographic and tumor-related information was collected, as was patient compliance with radiation treatment. Total dose, length of treatment, and theoretical "loss of loco-regional control" was calculated. Benchmark compliance data were obtained from select publications. Results: Of 136 patients, 55 did not begin treatment or transferred care elsewhere, leaving 81 study patients. Twenty-eight patients (35%) had unacceptable overall treatment courses. Forty-eight patients (59%) received less than the effective dose of 65 Gy after accounting for missed treatment days. Fifty-one patients (63%) had a greater than 10% calculated loss in loco-regional control. Univariate and multivariate analysis yielded no predictive value for gender, ethnicity, node status, stage, or primary site on compliance. Conclusion: Compared with other institutions, HNSCC patients in this setting are less likely to complete a prescribed therapeutic regimen. Patient and tumor characteristics measured in this study do not predict compliance. Organ preservation protocols require further evaluation in populations where compliance is suspect. Future research must examine interventions to improve compliance and assessment of its impact on survival.