{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T12:55:46Z","timestamp":1791896146471,"version":"4.3.4"},"reference-count":37,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to investigate the potential benefit of survival of receiving timely postoperative radiation therapy (PORT) for head and neck cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Retrospective cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>National Cancer Database from 2004 to 2020.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients with a diagnosis of human papilloma virus (HPV)\u2010negative head and neck squamous cell carcinoma who received adjuvant radiation were included. Exposure groups included timely PORT or delayed PORT (\u226442 or &gt;42 days from surgery to radiotherapy, respectively). The primary outcome was 5\u2010year overall survival (OS). Inverse probability weighted models were used to estimate OS in the counter\u2010factual scenario that all patients started radiation within 6 weeks while adjusting for confounding. Observed OS was for the entire cohort, while predicted OS was for the generated model of universal timely PORT within 6 weeks. Survival analyses were replicated for demographic and clinical subgroups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In total, 58,184 patients were included. Patients were mostly male, white, and non\u2010Hispanic. The observed average 5\u2010year OS was similar to the predicted OS (observed 0.58, 95% CI: 0.57\u20100.578; predicted 0.58, 95% CI: 0.57\u20100.59). The largest predicted benefit for timely PORT was seen in privately insured, white, rural, males, and with hypopharyngeal and stage IV cancer, though confidence intervals included the null hypothesis. Conversely, black patients were predicted to have a decline in OS with timely PORT (observed 0.54, 95% CI 0.53\u20100.56; predicted 0.50, 95% CI 0.46\u20100.52).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>For the overall cohort and other subgroups, even if optimally implemented, timely PORT is not predicted to improve OS. Modeling outcomes can guide resource allocation to the most impactful interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ohn.70484","type":"journal-article","created":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T12:37:11Z","timestamp":1791895031000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Potential Benefit of Effective Implementation of Timely Postoperative Radiation for Head and Neck Cancer"],"prefix":"10.1002","author":[{"given":"Peter Q.","family":"Luong","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Saint Louis University School of Medicine St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexis L.","family":"Hartman","sequence":"additional","affiliation":[{"name":"St Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa M.","family":"Velez\u2010Velez","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Saint Louis University School of Medicine St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Mazul","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2015-9855","authenticated-orcid":false,"given":"Sean T.","family":"Massa","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Saint Louis University School of Medicine St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,13]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Head and Neck Cancers. National Comprehensive Cancer Network Inc."},{"issue":"8","key":"e_1_2_9_3_1","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1001\/jamaoto.2022.1389","article-title":"Head and neck oncology is on the national quality sidelines no longer\u2014put me in, coach","volume":"148","author":"Graboyes EM","year":"2022","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"issue":"7","key":"e_1_2_9_4_1","doi-asserted-by":"crossref","first-page":"1676","DOI":"10.1002\/hed.27380","article-title":"Update on adherence to guidelines for time to initiation of postoperative radiation for head and neck squamous cell carcinoma","volume":"45","author":"Lorenz FJ","year":"2023","journal-title":"Head Neck"},{"issue":"24","key":"e_1_2_9_5_1","doi-asserted-by":"crossref","first-page":"4841","DOI":"10.1002\/cncr.30939","article-title":"Effect of time to initiation of postoperative radiation therapy on survival in surgically managed head and neck cancer","volume":"123","author":"Graboyes EM","year":"2017","journal-title":"Cancer"},{"issue":"10","key":"e_1_2_9_6_1","doi-asserted-by":"crossref","first-page":"e1512","DOI":"10.1200\/OP.20.00943","article-title":"Development and evaluation of a navigation\u2010based, multilevel intervention to improve the delivery of timely, guideline\u2010adherent adjuvant therapy for patients with head and neck cancer","volume":"17","author":"Graboyes EM","year":"2021","journal-title":"JCO Oncol Pract"},{"issue":"5","key":"e_1_2_9_7_1","doi-asserted-by":"crossref","first-page":"1265","DOI":"10.1002\/ohn.835","article-title":"Factors associated with head and neck cancer postoperative radiotherapy delays: a systematic review and meta\u2010analysis","volume":"171","author":"Duckett KA","year":"2024","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"6","key":"e_1_2_9_8_1","doi-asserted-by":"crossref","first-page":"1358","DOI":"10.1002\/lio2.692","article-title":"An equity\u2010based narrative review of barriers to timely postoperative radiation therapy for patients with head and neck squamous cell carcinoma","volume":"6","author":"Noyes EA","year":"2021","journal-title":"Laryngoscope Investig Otolaryngol"},{"issue":"1","key":"e_1_2_9_9_1","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1177\/0194599818768254","article-title":"Reducing the time from surgery to adjuvant radiation therapy: an institutional quality improvement project","volume":"159","author":"Divi V","year":"2018","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"28","key":"e_1_2_9_10_1","doi-asserted-by":"crossref","first-page":"3661","DOI":"10.1002\/sim.6607","article-title":"Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies","volume":"34","author":"Austin PC","year":"2015","journal-title":"Stat Med"},{"issue":"4","key":"e_1_2_9_11_1","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1093\/jnci\/djy202","article-title":"Race, poverty, and initial implementation of precision medicine for lung cancer","volume":"111","author":"Kehl KL","year":"2019","journal-title":"JNCI J Natl Cancer Inst"},{"key":"e_1_2_9_12_1","doi-asserted-by":"crossref","first-page":"2783","DOI":"10.1002\/lary.32074","article-title":"Survival associations of timely postoperative radiotherapy among head and neck cancer high\u2010risk subgroups","volume":"135","author":"Velez Velez LM","year":"2025","journal-title":"Laryngoscope"},{"key":"e_1_2_9_13_1","unstructured":"Data from: National Cancer Data Base.2024. 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