Update on adherence to guidelines for time to initiation of postoperative radiation for head and neck squamous cell carcinoma

Background: A prior study reported that over half of patients with HNSCC initiated PORT after 6 weeks from surgery during 2006–2014. In 2022, the CoC released a quality metric for patients to initiate PORT within 6 weeks. This study provides an update on time to PORT in recent years. Methods: The NCDB and TriNetX Research Network were queried to identify patients with HNSCC who received PORT during 2015–2019 and 2015–2021, respectively. Treatment delay was defined as initiating PORT beyond 6 weeks after surgery. Results: In NCDB, PORT was delayed for 62% of patients. Predictors of delay included age >50, female sex, black race, nonprivate insurance/uninsured status, lower education, oral cavity site, negative surgical margins, increased postoperative length of stay, unplanned hospital readmissions, IMRT radiation modality, treatment at an academic hospital or in the Northeast, and surgery and radiation at different facilities. In TriNetX, 64% experienced treatment delay. Additional associations with prolonged time to treatment included never married/divorced/widowed marital status, major surgery (neck dissection/free flaps/laryngectomy), and gastrostomy/tracheostomy dependence. Conclusions: There continue to be challenges to timely initiation of PORT.