In their invited commentary for the American Head and Neck Society, published in the JAMA Otolaryngology Head Neck Surg journal on July 9, 2023, Dr. Evan M. Graboyes and Dr. Sue S. Yom delve into the critical issues surrounding treatment delays in oral cavity cancer, emphasizing the significant impacts these delays have on patient outcomes. Their analysis, titled “Treatment Delays in Oral Cavity Cancer—Time, Time, Time, See What’s Become of Me,” not only sheds light on the complexities of delivering timely care but also underscores the necessity for integrated approaches to improve survival rates and disease-free outcomes.

The Urgency of Timely Care

Graboyes and Yom highlight the foundational pillars of quality cancer care: timeliness and multidisciplinary coordination. Particularly in the context of Head and Neck cancer (HNC), these elements are paramount due to the intricate nature of treatment plans involving surgical, radiation, and medical oncology teams. The authors point to the American College of Surgeons/Commission on Cancer’s endorsement of initiating adjuvant radiation therapy within six weeks post-surgery as a critical quality metric for HNC, drawing parallels with other cancer treatments where timely, coordinated care is a marker of quality.

The Impact of Delays in Treatment

The commentary draws on a multicenter retrospective cohort study by Dayan et al., analysing 1368 patients with oral cavity cancer across Canada. This study presents three major findings: the high prevalence of treatment initiation delays, the relative infrequency of interruptions once treatment begins, and the association of such delays with poorer oncologic outcomes, including overall survival (OS) and disease-free survival (DFS). These findings, while aligning with existing literature, add significant weight due to the study’s comprehensive scope and the multidisciplinary makeup of its authors.

Addressing Methodological and Clinical Gaps

While the association between treatment delays and worsened outcomes is not novel, Graboyes and Yom appreciate the methodological rigor and national scope of Dayan et al.’s study. It contributes to a growing body of evidence underscoring the need for swift action post-surgery to avoid adverse outcomes associated with delayed postoperative radiation therapy (PORT). They discuss the radiobiological principle of accelerated repopulation post-surgery, which necessitates prompt commencement of PORT to improve locoregional control and survival rates.

The Path Forward

The commentary advocates for an in-depth examination of the barriers leading to treatment delays, suggesting that postoperative complications and wound healing issues are significant contributors. This insight directs future efforts towards enhancing surgical and reconstructive techniques to minimize complications and ensure timely transition to adjuvant therapies. Moreover, the authors call for attention to early recurrences in the postoperative setting, emphasizing the role of vigilant multidisciplinary teams in identifying and managing such cases to optimize patient readiness for adjuvant therapy.

A Call for Multidisciplinary Engagement

Echoing the sentiment of deep multidisciplinary engagement, Graboyes and Yom argue for the necessity of collaboration across various healthcare specialties to address the complexities of delivering timely care in HNC. They envision a future where integrated healthcare systems and national cooperative groups undertake prospective interventions to improve coordinated care, reflecting a broader community’s commitment to enhancing treatment outcomes.


The commentary by Dr. Evan M. Graboyes and Dr. Sue S. Yom is a compelling call to action for the head and neck cancer community. It underscores the dire consequences of treatment delays in oral cavity cancer and the imperative to adopt a multidisciplinary approach to ensure timely, quality care. Their analysis, rooted in the study by Dayan et al., serves as a crucial contribution to the ongoing discourse on improving oncologic outcomes through enhanced coordination and timeliness in cancer care. As the field moves forward, the insights provided by Graboyes, Yom, and their colleagues will undoubtedly guide efforts to mitigate treatment delays and promote a patient-centered approach to cancer treatment.

Prof. Dr. Prahlada N. B
16 March 2024

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