Quantitative survival impact of composite treatment delays in head and neck cancer

BACKGROUND Multidisciplinary management of head and neck cancer (HNC) must reconcile increasingly sophisticated subspecialty care with timeliness of care. Prior studies examined the individual effects of delays in diagnosis‐to‐treatment interval, postoperative interval, and radiation interval but did not consider them collectively. The objective of the current study was to investigate the combined impact of these interwoven intervals on patients with HNC. METHODS Patients with HNC who underwent curative‐intent surgery with radiation were identified in the National Cancer Database between 2004 and 2013. Multivariable models were constructed using restricted cubic splines to determine nonlinear relations with overall survival. RESULTS Overall, 15,064 patients were evaluated. After adjustment for covariates, only prolonged postoperative interval (P