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Purpose <p>To evaluate the association between the operational implementation of a Fast-Track referral pathway for head and neck cancer and changes in care intervals, tumor profile at diagnosis, and overall survival in a real-world tertiary care cohort.</p> Patients and methods <p>Retrospective observational historical cohort study including patients with a primary malignant ENT tumor treated between January 2010 and August 2023. Patients were classified according to diagnostic period as Pre-Fast-Track or Post-Fast-Track, using January 2018 as the operational implementation date. Care intervals, tumor characteristics, route of entry into the pathway, and overall survival were analyzed.</p> Results <p>A total of 1106 patients were included: 614 in the Pre-Fast-Track period and 492 in the Post-Fast-Track period. After implementation, median referral time decreased from 9 to 5&#xa0;days, first ENT consultation-to-treatment time from 27 to 21&#xa0;days, and referral-to-treatment time from 50 to 43&#xa0;days, all <i>p</i> &lt; 0.001. The Post-Fast-Track period also showed a lower proportion of stage III–IV disease. Among post-implementation patients with available data, 22.8% entered through the Fast-Track pathway. Kaplan–Meier curves showed no significant survival differences between periods (log-rank, <i>p</i> = 0.95). In the multivariable Cox model, the Post-Fast-Track period was not independently associated with overall survival (adjusted HR 0.94; 95%CI 0.77–1.15; <i>p</i> = 0.537).</p> Conclusions <p>The operational implementation of a Fast-Track pathway was associated with shorter care intervals and a relatively less advanced-stage distribution at diagnosis, but not with improved overall survival. Its clinical impact may depend on pathway penetration and the efficiency of the entire diagnostic–therapeutic process.</p>

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Impact of fast-track pathway implementation on time to diagnosis, stage at diagnosis, and overall survival in head and neck cancer

  • 期刊论文

  • 发表日期：

    2026年6月19日

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  • Pedro Rodríguez Lorenzana,
  • Nicolás González Poggioli,
  • Laura Arias Soilán,
  • Andrea Cores Nogueira,
  • Henar González Rodríguez,
  • Miguel Mayo Yáñez,
  • Pablo Parente Arias

摘要

Purpose

To evaluate the association between the operational implementation of a Fast-Track referral pathway for head and neck cancer and changes in care intervals, tumor profile at diagnosis, and overall survival in a real-world tertiary care cohort.

Patients and methods

Retrospective observational historical cohort study including patients with a primary malignant ENT tumor treated between January 2010 and August 2023. Patients were classified according to diagnostic period as Pre-Fast-Track or Post-Fast-Track, using January 2018 as the operational implementation date. Care intervals, tumor characteristics, route of entry into the pathway, and overall survival were analyzed.

Results

A total of 1106 patients were included: 614 in the Pre-Fast-Track period and 492 in the Post-Fast-Track period. After implementation, median referral time decreased from 9 to 5 days, first ENT consultation-to-treatment time from 27 to 21 days, and referral-to-treatment time from 50 to 43 days, all p < 0.001. The Post-Fast-Track period also showed a lower proportion of stage III–IV disease. Among post-implementation patients with available data, 22.8% entered through the Fast-Track pathway. Kaplan–Meier curves showed no significant survival differences between periods (log-rank, p = 0.95). In the multivariable Cox model, the Post-Fast-Track period was not independently associated with overall survival (adjusted HR 0.94; 95%CI 0.77–1.15; p = 0.537).

Conclusions

The operational implementation of a Fast-Track pathway was associated with shorter care intervals and a relatively less advanced-stage distribution at diagnosis, but not with improved overall survival. Its clinical impact may depend on pathway penetration and the efficiency of the entire diagnostic–therapeutic process.