An Audit and Analysis of Causes of Treatment Default in Head and Neck Cancer: A Single Tertiary Cancer Centre Experience

Background: Treatment default is widespread among cancer patients and usually compromise patients’ clinical outcome. This not only compromises the management plan but also makes it harder to measure our treatment outcomes. Method: We reviewed Outpatient department (OPD) clinical record files of head and neck cancer patients who were registered at our hospital in a year. Patients were chosen on the basis of availability of record files at the time of sampling. All patients' OPD files were evaluated for treatment completion and causes of treatment default were recorded from the OPD record file. If information was not available in the OPD record file, patients or patients' relatives (if a contact number was available) were called for further information and cause of default. The Google spreadsheet was prepared to record demographics and causes of treatment default. Results: 72.19% were male among 205 patients analysed for the study. Most common site was oral cavity (30.24%), followed by oropharynx (21.9%), larynx (20%) and others. Intent was curative in 175 patients (85.36%) and palliative in 22patients (10.73%). 112 curative intent patients (64%) and 11 palliative intent (50%) completed planned treatment, 27 curative intent patients (15.42%) and 7 palliative patients (31.81%) defaulted during treatment and 36 curative patients (20.57%) and 4 palliative patients (18.18%) defaulted before starting Primary treatment (Surgery or Radiotherapy). Treatment related toxicities in 20 patients (26.31%) waiting time for radiotherapy in 14 patients (18.42%) were major causes of default in this study. In curative intent cases, 44 patients (39.28%) had complete response, 41 patients (36.3%) had partial response, 10 patients (8.92%) had progressive disease and 6 patients (5.35%) had metastatic disease, 3-month post treatment. Conclusion: Among various reasons for noncompliance, few can be addressed immediately like arranging multidisciplinary team discussions at an institutional level to prioritize management. Further large-scale studies are needed to estimate the exact dimensions of the issues in our setup.