Purpose/Objective(s): Multidisciplinary care (MDC) optimizes diagnosis, staging, treatment, and outcomes of oncology patients and improves patient satisfaction. We analyzed the impact of MDC on the time to treatment initiation (TTI) for United States Medicare patients treated for head and neck squamous cell carcinomas (HNSCC).

Materials/Methods: Using Survival, Epidemiology, and End Results (SEER)-Medicare linked data, we selected patients age > 65 who were treated for HNSCC of the oral cavity, oropharynx, hypopharynx, nasopharynx, and larynx from 1991-2011. MDC was defined according to stage. For stages 0-II cancer, MDC included a post-diagnosis, pre-treatment evaluation by an otolaryngologist/ head and neck surgeon and radiation oncologist. For stages III-IV cancer, MDC also included pre-treatment evaluation by a medical oncologist. TTI was defined as the interval between diagnosis and surgical resection or initiation of (chemo)radiation. TTI-A was defined as that interval from surgical resection to start of adjuvant (chemo)radiation. Cohort characteristics and treatment patterns were summarized using descriptive statistics. The Wilcoxon rank sum test was used to compare treatment delays by receipt of MDC.

Results: We identified 19,782 eligible patients of whom 71% were men with median age of 74 years, 56% had SCC of the larynx, and 72% were initially treated with non-surgical therapy. Greater than 90% of patients treated with surgery or (chemo)radiation (irrespective of MDC) initiated therapy within 0-60 or 1-60 days, respectively. 71.3% of early stage (n=10,419) and 29.8% of advanced stage (n=9363) patients experienced MDC. Receipt of MDC was associated with an almost 1-week delay in median TTI for all patients (25 versus 19 days for the non-MDC cohort, p<0.001, see Table). MDC delayed TTI by 5 and 8 days for early and advanced stage disease, respectively. Of note, 16.9% of patients treated with initial surgery (n=5545) underwent a simultaneously diagnostic and therapeutic surgical procedure. There were 2606 (13.1%) patients who had resection and adjuvant (chemo)radiation, of whom 8.7% had MDC. Receipt of MDC did not impact median TTI-A for adjuvant radiation or chemoradiation (see Table).

Conclusion: Although receipt of MDC is associated with a 5-9 day delay in initiation of definitive therapy for elderly HNSCC patients in the United States, the median TTI for these patients is still less than 4 weeks. Conversely, receipt of MDC prior to an operation does not shorten treatment package time, although this is largely secondary to expeditious adjuvant treatment initiation even in the absence of MDC. Given the minimally prolonged TTI, avoidance of MDC in an effort to expedite therapy does not seem justified.

	Median TTI (days)
MDC	+	-	p
Early Stage	23	18	<0.001
Adv Stage	28	19	<0.001
	Median TTI-A (days)
MDC	+	-	p
Adj RT	33	34	0.49
Adj CRT	28	29	0.82