{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T07:06:22Z","timestamp":1780038382358,"version":"3.53.1"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Approximately 60% of patients with head and neck squamous cell carcinoma are diagnosed with locally advanced disease (LA-HNSCC), which is associated with a high risk of recurrence, distant metastasis, and poor prognosis. A multidisciplinary approach is recommended for comprehensive care, resulting in a substantial burden on the healthcare system. The TRACE2 study aimed to describe patients\u2019 clinical characteristics, healthcare resource utilization (HCRU), and costs associated with LA-HNSCC management in real-world practice in Portugal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Non-interventional, retrospective cohort study conducted in four Portuguese hospitals between 30\/11\/2021-04\/03\/2024, including adult patients diagnosed between 01\/06\/2016-31\/05\/2018 who were eligible for curative treatment. Secondary data were collected from medical records from the time of diagnosis until recurrence, death, loss to follow-up, or the cut-off date (31\/12\/2020), whichever occurred first. The financial analysis was conducted from the perspective of the Portuguese public healthcare payer, considering only direct medical costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The study included 150 patients (94.7% male; 91.3% aged 50\u201379 years), with a high prevalence of tobacco (92.0%) and heavy alcohol (83.1%) use. Combined systemic therapy and radiotherapy (ST+RT) was the most frequent treatment (81.3%), whereas a minority underwent surgery (17.3%) or RT without ST (13.3%). During a median follow-up of 12 months, over 89% of patients required outpatient consultations and medical exams. Hospitalizations and emergency consultations were reported in 74.5% and 37.6% of patients, respectively. Overall, supportive care, including nutritional support (85.2%), psychological treatment (16.1%), and speech therapy (8.7%), were used by fewer patients. HCRU was generally higher during treatment than after its completion or discontinuation. The global median (P25; P75) annualized cost per patient was \u20ac7,706.0 (3,775.8; 20,784.8), with the primary cost drivers being ST+RT and hospitalizations, followed by outpatient consultations and imaging assessments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The TRACE2 study provides the first comprehensive description of LA-HNSCC management in real-world practice in Portugal, underscoring the burden on both patients and the healthcare system. Given the persistently high proportion of patients diagnosed with locally advanced disease, these findings offer supporting evidence for the implementation of measures to improve patient follow-up protocols and resource allocation, ultimately enhancing patient outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1773554","type":"journal-article","created":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T06:52:55Z","timestamp":1780037575000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Real-world healthcare resource use and costs associated with the management of locally advanced head and neck cancer in Portugal \u2013 TRACE2 study"],"prefix":"10.3389","volume":"16","author":[{"given":"Maria Margarida","family":"Teixeira","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, Instituto Portugu\u00eas de Oncologia de Coimbra Francisco Gentil","place":["Coimbra, Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joana","family":"Magalh\u00e3es","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Unidade Local de Sa\u00fade do Algarve","place":["Faro, Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joana","family":"Marinho","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Unidade Local de Sa\u00fade Gaia e Espinho","place":["Vila Nova de Gaia, Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katia","family":"Ladeira","sequence":"additional","affiliation":[{"name":"Department of Oncology, Unidade Local de Sa\u00fade de Tr\u00e1s-os-Montes e Alto Douro","place":["Vila Real, Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catarina","family":"Morais","sequence":"additional","affiliation":[{"name":"MSD Portugal","place":["Pa\u00e7o de Arcos, Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mafalda","family":"Nogueira","sequence":"additional","affiliation":[{"name":"MSD Portugal","place":["Pa\u00e7o de Arcos, Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1056\/nejmra1715715","article-title":"Head and neck cancer","volume":"382","author":"Chow","year":"2020","journal-title":"N Engl J Med"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J Clin"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djk179","article-title":"Alcohol drinking in never users of tobacco, cigarette smoking in never drinkers, and the risk of head and neck cancer: pooled analysis in the International Head and Neck Cancer Epidemiology Consortium","volume":"99","author":"Hashibe","year":"2007","journal-title":"J Natl Cancer Inst"},{"key":"B4","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1097\/jom.0000000000001563","article-title":"Occupations and the risk of head and neck cancer: a pooled analysis of the International Head and Neck Cancer Epidemiology (INHANCE) Consortium","volume":"61","author":"Khetan","year":"2019","journal-title":"J Occup Environ Med"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2015.12.017","article-title":"Head and neck squamous cell carcinoma: update on epidemiology, diagnosis, and treatment","volume":"91","author":"Marur","year":"2016","journal-title":"Mayo Clin Proc"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mds299","article-title":"Treatment choice for locally advanced head and neck cancers on the basis of risk factors: biological risk factors","volume":"23","author":"Braakhuis","year":"2012","journal-title":"Ann Oncol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.4155\/fsoa-2018-0058","article-title":"Genetics and management of locally advanced carcinomas of the head and neck: role of altered fractionation radiotherapy","volume":"5","author":"Perri","year":"2019","journal-title":"Future Sci OA"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1002\/lary.32064","article-title":"The evolution of multidisciplinary head and neck cancer treatment","volume":"135","author":"Contrera","year":"2025","journal-title":"Laryngoscope"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2018.0026","article-title":"NCCN guidelines insights: head and neck cancers, version 1.2018","volume":"16","author":"Colevas","year":"2018","journal-title":"J Natl Compr Canc Netw"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2020.07.011","article-title":"Squamous cell carcinoma of the oral cavity, larynx, oropharynx and hypopharynx: EHNS-ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"31","author":"Machiels","year":"2020","journal-title":"Ann Oncol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12062303","article-title":"Transoral robotic surgery for head and neck cancer: advances and residual knowledge gaps","volume":"12","author":"Mella","year":"2023","journal-title":"J Clin Med"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.2147\/cmar.s115761","article-title":"Head and neck cancer: improving outcomes with a multidisciplinary approach","volume":"9","author":"Lo Nigro","year":"2017","journal-title":"Cancer Manag Res"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1007\/s40273-014-0169-3","article-title":"The economic burden of head and neck cancer: a systematic literature review","volume":"32","author":"Wissinger","year":"2014","journal-title":"Pharmacoeconomics"},{"key":"B14","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1177\/0194599819897265","article-title":"Global burden of head and neck cancer: economic consequences, health, and the role of surgery","volume":"162","author":"Patterson","year":"2020","journal-title":"Otolaryngol Head Neck Surg"},{"key":"B15","volume-title":"Methods for the Economic Evaluation of Health Care Programs","author":"Drummond","year":"2015"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2023.101964","article-title":"Prevalence of locoregional recurrence and survival post-treatment of head and neck cancers in Africa: a systematic review and meta-analysis","volume":"59","author":"Melariri","year":"2023","journal-title":"eClinicalMedicine"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.2139\/ssrn.4971476","article-title":"Global burden and gender disparities in head and neck cancers among adults aged 40-64, 1990-2021: a systematic analysis from the Global Burden of Disease Study 2021","volume":"8","author":"Luo","year":"2025","journal-title":"Cancer Rep (Hoboken)"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.3390\/curroncol31080318","article-title":"Real-world healthcare resource use associated with recurrent or metastatic head and neck cancer patients care in Portugal-TRACE study","volume":"31","author":"Teixeira","year":"2024","journal-title":"Curr Oncol"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.3390\/medsci11020042","article-title":"Epidemiology, risk factors, and prevention of head and neck squamous cell carcinoma","volume":"11","author":"Barsouk","year":"2023","journal-title":"Med Sci (Basel)"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6733a2","article-title":"Trends in human papillomavirus-associated cancers - United States, 1999-2015","volume":"67","author":"Van Dyne","year":"2018","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.3390\/cancers11010015","article-title":"Induction chemotherapy in head and neck squamous cell carcinoma: a question of belief","volume":"11","author":"Karabajakian","year":"2019","journal-title":"Cancers"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1016\/j.esmoop.2021.100309","article-title":"Squamous cell carcinoma of the head and neck: EHNS-ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"21","author":"Gregoire","year":"2010","journal-title":"Ann Oncol"},{"key":"B23","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1016\/j.radonc.2011.05.036","article-title":"Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): a comprehensive analysis by tumor site","volume":"100","author":"Blanchard","year":"2011","journal-title":"Radiother Oncol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1016\/j.radonc.2009.04.014","article-title":"Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomized trials and 17,346 patients","volume":"92","author":"Pignon","year":"2009","journal-title":"Radiother Oncol"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2019.00086","article-title":"Low-dose vs. high-dose cisplatin: lessons learned from 59 chemoradiotherapy trials in head and neck cancer","volume":"9","author":"Szturz","year":"2019","journal-title":"Front Oncol"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2024.1430845","article-title":"Nutrition in HNSCC: is it a matter for oncologists? The role of multidisciplinary team-a narrative literature review","volume":"14","author":"Denaro","year":"2024","journal-title":"Front Oncol"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnesp.2023.10.033","article-title":"Nutritional prehabilitation in head and neck cancer: a systematic review of literature","volume":"58","author":"De Pasquale","year":"2023","journal-title":"Clin Nutr ESPEN"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1017\/s0022215116000608","article-title":"Speech and swallow rehabilitation in head and neck cancer: United Kingdom National Multidisciplinary Guidelines","volume":"130","author":"Clarke","year":"2016","journal-title":"J Laryngol Otol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"478","DOI":"10.1186\/s12885-021-08236-2","article-title":"Screening for distress, related problems and perceived need for psycho-oncological support in head and neck squamous cell carcinoma (HNSCC) patients: a retrospective cohort study","volume":"21","author":"Kunz","year":"2021","journal-title":"BMC Cancer"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1515\/sjpain-2020-0067","article-title":"Pain management in patients undergoing radiation therapy for head and neck cancer - a descriptive study","volume":"21","author":"Schaller","year":"2021","journal-title":"Scand J Pain"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1016\/j.oor.2024.100569","article-title":"End of life and palliative care decisions in advanced head neck cancer","volume":"11","author":"Mali","year":"2024","journal-title":"Oral Oncol Rep"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2022.103675","article-title":"Concordant palliative care delivery in advanced head and neck cancer","volume":"44","author":"Cannon","year":"2023","journal-title":"Am J Otolaryngol"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.2147\/ceor.s198312","article-title":"Clinical and economic burden of head and neck cancer: a nationwide retrospective cohort study from France","volume":"11","author":"Schernberg","year":"2019","journal-title":"Clinicoecon Outcomes Res"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2023.106316","article-title":"Is locally advanced head and neck cancer 'increasing' in the Netherlands? The paradox of absolute numbers, standardized incidence rates and proportional share","volume":"138","author":"van Beers","year":"2023","journal-title":"Oral Oncol"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1016\/j.lana.2024.100986","article-title":"Disparities in stage at diagnosis of head and neck tumors in Brazil: a comprehensive analysis of hospital-based cancer registries","volume":"42","author":"Nascimento de Carvalho","year":"2025","journal-title":"Lancet Reg Health Am"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1200\/go-24-00285","article-title":"Changing landscape of head and neck squamous cell carcinoma and nasopharyngeal carcinoma treatment and survival trends in Thailand: a 13-year multicenter retrospective study of patients","volume":"11","author":"Ngamphaiboon","year":"2025","journal-title":"JCO Glob Oncol"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1773554\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T06:52:56Z","timestamp":1780037576000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1773554\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,29]]},"references-count":36,"alternative-id":["10.3389\/fonc.2026.1773554"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1773554","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,29]]},"article-number":"1773554"}}