. Author manuscript; available in PMC: 2019 Aug 6.

Published in final edited form as: JAMA Otolaryngol Head Neck Surg. 2019 Feb 1;145(2):166–177. doi: 10.1001/jamaoto.2018.2716

Table 1.

Diagnosis to Treatment Initiation (DTI)

Source	Country	Definition of Delayed DTI	Derivation of Definition of Delay	Data Source	Sample Size, No.	Years of Diagnosis or Treatment	Freq of Delay, %	HN Subsite, %	AJCC Stage Grouping,%	Treatment Modality, %	Association of Delay to Survival, aHR(95%CI)	Quality Score
Chen et al,¹⁹ 2018	United States	>30 d	Calendar-based (1 mo)	Single academic medical center	132	2008–2016	NR	OC: 100	Pathologic I: 7 II: 18 III: 12 IV: 63	S + RT: 63 S + CRT: 37	OS ≤30 d, 1 [Ref] >30 d, 1.07 (0.43–2.67) RFS ≤30 d, 1 [Ref] >30 d, 1.55 (0.73–3.29)	11
Cheraghlou et al,²² 2017	United States	>100 d	Not specified	National sample of CoC-accredited hospitals	5627	2004–2012	>100 d: 1	Lx: 100	Clinical I: 50 II: 50	S: 11 S + RT: 19 RT: 69	OS ≤100 d, 1 [Ref] >100 d: 1.6 (NR)	11
Fujiwara et al,³⁰ 2017	United States	≥45 d	Cohort quartiles	National sample of CoC-accredited hospitals	4868	1998–2011	≥45 d: 25	OC: 100	Unspecified I: 39 II: 22 III: 10 IV: 29	S: 70 S + RT: 20 S + CRT: 10	OS ≤30 d, 1 [Ref] 30–45 d, NR ≥45 d, 0.98 (0.88–1.09)	12
Tsai et al,³¹ 2017	Taiwan	>120 d	Not specified	Population-based cancer registry	21 263	2004–2010	>120 d: 3	OC: 100	Unspecified I: 28 II: 20 III: 12 IV: 40	S: 93 RT: 5 chemotherapy: 2	OS <30 d, 1 [Ref] 31–120 d, 1.18 (1.11–1.25) ≥120 d, 1.32 (1.19–1.47)	12
Liao et al,³² 2017	Taiwan	1: >30 d 2: >20 d	1: Calendar-based (mo) 2: RPA	Population-based cancer registry	18 677	2004–2010	1: >30 d: 19 2: >20 d: 43	OC: 100	Clinical I: 18 II: 37 III: 10 IV: 26	S: 93 (C)RT: 7	OS (calendar-based) ≤30 d, 1 [Ref] 31–60 d, 1.10 (1.03–1.18) 61–90 d, 1.26 (1.08–1.46) ≥91 d, 1.26 (1.12–1.41) OS (RPA) ≤20 d, 1 [Ref] 21–45 d, 1.07 (1.02–1.13) 46–90 d, 1.25 (1.14–1.38) ≥91 d, 1.28 (1.14–1.45)	12
Polesel et al,³³ 2017	Italy	>45 d	Not specified	Population-based cancer registry	1616	2003–2009	>45 d, 25	OC: 29 OP: 21 HP: 13 Lx: 37	Unspecified I: 18 II: 7 III: 6 IV: 26 Unk: 43	S: 37 RT: 10 CRT: 30 IC + RT: 23	OS ≤30 d, 1 [Ref] 31–44 d, 1.08 (0.90–1.30) 45–89 d, 1.13 (0.92–1.39) ≥90 d, 1.47 (1.05–2.05)	13
Murphy et al,¹⁰ 2016	United States	1: >60 d 2: >67 d	1.: Calendar-based (mo) 2: RPA	National sample of CoC-accredited hospitals	51655	2003–2005	1: >60 d, 10 2: >67 d, NR	OC: 29 OP: 22 HP: 7 Lx: 42	Clinical I: 24 II: 16 III: 21 IV: 39	S: 19 S + RT: 17 S + CRT: 11 RT: 23 CRT: 31	OS (calendar-based) ≤30 d, 1 [Ref] 31–60 d, 0.99 (0.96–1.02) 61–90 d, 1.08 (1.03–1.13) ≥91 d, 1.23 (1.15–1.32) Median OS (RPA) ≤46–52 d, 72 mo 53–67 d, 61 mo >67 d, 47 mo	13
Sharma et al,³⁴ 2016	United States	>30 d	Cohort median	National sample of CoC-accredited hospitals	6606	2003–2006	>30 d: 54	OP: 100	Clinical III: 26 IV: 74	CRT: 100	OS ≤30 d, 1 [Ref] >30 d, 1.12 (1.03–1.20)	11
Chiou et al,³⁵ 2016	Taiwan	>21 d	Calendar-based (wk, as determined by P values)	Population-based cancer registry	2703	2007-not specified	>21 d: 59	OC: 100	Unspecified 0: 1 I: 21 II: 20 III: 17 IV: 41	NR	Median OS <21 d, 60.7 mo >21 d, 62.7 mo	10
Naghavi et al,³⁶ 2016	United States	>45 d	Not specified	Single academic medical center	1802	1998–2013	>45 d: 51	OP: 47 OC: 25 Lx: 19 HP: 5	Unspecified I: 6 II: 9 III: 18 IV: 67	S + (C)RT: 32 (C)RT: 63	OS ≤45 d, 1 [Ref] >45 d, 1.75 (1.06–2.88)	11
Van Harten et al,³⁷ 2015	Netherlands	>30 d	Calendar-based (wk)	National Cancer Registry	13 140	2005–2011	>30 d: 65	OC: 33 OP: 19 NP: 7 HP: 7 Lx: 28 salivary: 6	Unspecified I: 31 II: 18 III: 15 IV: 36	S: 29 S + (C)RT: 27 CRT: 44	OS 7 d, 1.07 (1.06–1.08)	13
Van Harten et al,³⁸ 2014	Netherlands	>30 d	Calendar-based (mo)	Single comprehensive cancer center	2493	1990–2011	>30 d: 68	OC: 27 OP: 33 HP: 11 Lx: 29	Unspecified I-II: 40 III-IV: 60	S ± (C)RT: 48 (C)RT: 52	DSS ≤30 d, 1 [Ref] >30 d, 0.91 (0.77–1.07)	12
Caudell et al,³⁹ 2011	United States	>51 d	Cohort quartiles	Single academic medical center	427	1995–2007	>51 d: 25	OC: 5 OP: 55 HP: 9 Lx: 21 Other: 10	Clinical III: 24 IV: 76	RT:28 CRT: 72	OS ≤24 d, 1 [Ref] 25–34 d, P = NS 35–50 d, P = NS ≥50 d, P = .47 (HR, NR) LRC ≤24 d, 1 [Ref] 25–34 d, P = NS 35–50 d, P = NS ≥50 d, P = .22 (HR, NR)	10

Abbreviations: aHR, adjusted hazard ratio; AJCC, American Joint Committee on Cancer; CoC, Commission on Cancer; CRT, chemoradiotherapy; DSS, disease-specific survival; Freq, Frequency; HR, hazard ratio; HP, hypopharynx; HN, head and neck; IC, induction chemotherapy; LRC, locoregional control; Lx, larynx; NP, nasopharynx; NR, not reported; NS, not significant (as reported by study authors without quantified P value); OC, oral cavity; OP, oropharynx; OS, overall survival; Ref, Reference; RFS, recurrence-free survival; RPA, recursive partition analysis; RT, radiotherapy; S, surgery; Unk, unknown.