# Simultaneous Head and Neck and Lung Cancers: Implications and Therapeutic Management Timing

## TL;DR

This study examines patients with both head and neck and lung cancers, finding that delays in treatment lead to worse survival outcomes.

## Contribution

The study identifies the impact of diagnosis-to-treatment intervals on survival in patients with simultaneous head and neck and lung cancers.

## Key findings

- Patients with simultaneous cancers had significantly longer diagnosis-to-treatment intervals (DTIs) compared to controls.
- Overall survival was markedly worse for patients with simultaneous cancers (median 17.8 months) versus controls (56.5 months).
- Integrated diagnostic procedures like concurrent bronchoscopy and endoscopy are suggested to reduce treatment delays.

## Abstract

This study aims to describe the characteristics of patients with simultaneous head and neck squamous cell carcinomas (HNSCCs) and lung cancer and to assess the impact of diagnosis‐to‐treatment interval (DTI) and treatment choices on outcomes.

A bicentric retrospective observational study conducted between 2003 and 2020 in two tertiary referral academic hospitals.

Forty‐three patients diagnosed with both HNSCC and lung cancer within 1 month were compared to a 1:2 control group of patients diagnosed with HNSCC alone. The groups were matched by tumour location, TNM stage and treatment centre. Multivariate analysis was used to assess factors influencing DTI, and survival analysis was conducted using the Kaplan–Meier estimator.

Primary outcomes included DTI and overall survival.

Patients with simultaneous cancers were predominantly male (84%) with heavy smoking histories. Most HNSCC cases (84%) were diagnosed at advanced stages (III/IV), while lung cancers were predominantly early stage (I–II). Patients with simultaneous cancers had significantly longer DTIs (median 43 days, IQR [32.8–85.8]) compared to controls (28 days, IQR [19.0–38.0]) (p < 0.001; HR = 0.35, p = 0.0001). As expected, overall survival was markedly worse for patients with simultaneous cancers (median 17.8 months, 95% CI [12.6–31.0]) versus controls (56.5 months, 95% CI [38.4–], p < 0.001).

Prolonged DTI may contribute to the poorer survival outcomes in patients with simultaneous cancers. Strategies to reduce delays, such as performing concurrent bronchoscopy and endoscopy, should be explored.

Simultaneous diagnoses of head and neck squamous cell carcinomas (HNSCCs) and lung cancer occur in 0.6%–1.4% of HNSCC patients, predominantly affecting males with heavy smoking histories.Among patients with simultaneous cancers, HNSCC cases were frequently advanced stage (III/IV), while lung cancers were primarily early‐stage adenocarcinomas (I–II in 60% of cases).Patients with simultaneous cancers experienced significantly longer diagnosis‐to‐treatment interval (DTIs) (median 43 days) compared to HNSCC‐only patients (28 days), with delays persisting even after adjusting for confounders (HR = 0.35, p = 0.0001).Simultaneous cancer patients had significantly worse overall survival (median 17.8 months) and recurrence‐free survival (median 31.5 months) compared to controls, highlighting the clinical impact of diagnostic and treatment delays.This study emphasises the need to reduce DTIs in simultaneous cancer cases, potentially through integrated diagnostic procedures like concurrent bronchoscopy and endoscopy, aligning with guidelines recommending treatment initiation within 28 days.

Simultaneous diagnoses of head and neck squamous cell carcinomas (HNSCCs) and lung cancer occur in 0.6%–1.4% of HNSCC patients, predominantly affecting males with heavy smoking histories.

Among patients with simultaneous cancers, HNSCC cases were frequently advanced stage (III/IV), while lung cancers were primarily early‐stage adenocarcinomas (I–II in 60% of cases).

Patients with simultaneous cancers experienced significantly longer diagnosis‐to‐treatment interval (DTIs) (median 43 days) compared to HNSCC‐only patients (28 days), with delays persisting even after adjusting for confounders (HR = 0.35, p = 0.0001).

Simultaneous cancer patients had significantly worse overall survival (median 17.8 months) and recurrence‐free survival (median 31.5 months) compared to controls, highlighting the clinical impact of diagnostic and treatment delays.

This study emphasises the need to reduce DTIs in simultaneous cancer cases, potentially through integrated diagnostic procedures like concurrent bronchoscopy and endoscopy, aligning with guidelines recommending treatment initiation within 28 days.