Early versus delayed inpatient radiotherapy in head and neck cancer and associated in-hospital outcomes.

Abstract

e18088 Background: Early initiation of radiotherapy (RT) in head and neck cancer (HNC) may improve outcomes by enhancing tumor control and reducing in-hospital complications. However, the patterns, predictors, and short-term outcomes associated with early inpatient RT remain poorly characterized. Methods: Using the Nationwide Inpatient Sample (NIS), we identified adult HNC admissions receiving inpatient RT between 2016–2020. Patients were stratified by RT timing: ≤48 hours (“early RT”) versus >48 hours (“delayed RT”). Weighted chi-square and independent-samples t-tests were used for unadjusted comparisons, and multivariable logistic regression determined predictors of early RT. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported. Results: Among approximately 454,000 weighted hospitalizations, 1.2% received RT within 48 hours. Early RT patients were younger (60.5 ± 14.3 vs 63.4 ± 14.7 years; p <0.001), had similar length of stay (6.6 vs 6.7 days; p =0.52), slightly lower total charges ($78,291 vs $85,013; p <0.001), and a higher Charlson Comorbidity Index (7.47 vs 7.34; p =0.007). Early RT occurred more often at large (72.0%), urban teaching hospitals (69.6%), and in the Mid-Atlantic region (44.4%) ( all p <0.001). Early RT was also more common among patients with private insurance (39.1% vs 26.0%), higher-income ZIPs (23.4% vs 20.1%), and Black race (17.5% vs 12.3%), p <0.001 for all. Unadjusted analyses showed significantly lower rates of in-hospital death (1.6% vs 4.8%), myocardial infarction (6.1% vs 7.6%), congestive heart failure (6.4% vs 9.9%), cerebrovascular accidents (3.4% vs 5.4%), sepsis (5.0% vs 11.9%), hemorrhage (6.3% vs 13.4%), organ failure (29.4% vs 36.9%), and major adverse cardiac events (MACE) (0.9% vs 4.5%) among early RT patients ( all p <0.001). In adjusted models, early RT was independently associated with frailty (aOR 1.81; 95% CI 1.70–1.92). Early RT was inversely associated with in-hospital death (aOR 0.71; 95% CI 0.56–0.90), sepsis (aOR 0.56; 95% CI 0.49–0.64), MACE (aOR 0.37; 95% CI 0.27–0.49), hemorrhage (aOR 0.60; 95% CI 0.53–0.67), and DNR status (aOR 0.82; 95% CI 0.73–0.93). Conclusions: Early initiation of inpatient RT (≤48 hours) confers a clear survival advantage and fewer in-hospital complications, reflecting the power of coordinated, time sensitive cancer care. Establishing early RT as a standard of practice could redefine inpatient oncology quality metrics and elevate institutional performance nationwide.