Delays in Radiation Therapy for Head and Neck Cancer: The Role of Pre-Radiation Dental Clearance.

Abstract

Head and neck cancer (HNC) guidelines recommend initiation of adjuvant radiation (RT) within 6 weeks of surgery. Preradiation dental clearance is critical, but its role in radiation delay is unknown. We sought to understand the relationship between dental clearance and RT delays in HNC patients. Retrospective cohort. Single-institution, HNC patients referred for pre-radiation dental clearance in 2023. Dental clearance delay (DCD) was defined as clearance more than 5 weeks following initial clinic, biopsy, or resection. Radiation treatment delay (RTD) was defined as adjuvant RT starting more than 6 weeks after cancer resection or primary RT starting more than 6 weeks after initial clinic visit or diagnostic biopsy. Multivariable logistic regressions were performed to identify predictors of RTD, DCD, and dental extractions. Of 160 patients meeting inclusion criteria, nearly 60% experienced RTD. Patients with increasing days from diagnosis to dental referral and increasing days from dental referral to clearance were more likely to experience RTD. DCD was more likely with increasing days from diagnosis to dental referral and among patients requiring dental extractions. Dental extractions were more likely with increasing age and Medicaid or no insurance compared to private insurance. Increasing time from diagnosis to dental referral and increasing time from dental referral to clearance were significantly associated with RTD. Patients requiring extractions were more likely to be older, on Medicaid or uninsured, and to experience DCD. These findings highlight patients with increased risk for RTD and inform future studies to streamline dental clearance.