REVEAL study - real-world database analysis of patients with locally advanced head and neck squamous cell carcinoma in Israel.

INTRODUCTION

We describe the epidemiology, primary treatment approaches and overall survival in a real-world cohort of patients with locally advanced HNSCC in 2.8-million-member healthcare provider in Israel.

METHODS

This study identified newly diagnosed patients aged ≥ 18 years between 2015 and 2022 using de-identified data from Maccabi Healthcare Services. Overall survival was estimated using Kaplan-Meier analysis. Outcomes were assessed at a minimum of 12 months follow-up (cut-off: 31 December 2023).

RESULTS

A total of 541 patients with locally advanced HNSCC were identified between January 2015 and December 2022. Of these, 23.7% were stage III (n = 128), 34.8% stage IVa (n = 188), 7.6% stage IVb (n = 41) and 34.0% unknown (n = 184). A total of 45.3% were ≥ 65 years, 29.8% female, 62.3% were former or current smokers and 39.7%, 31.4%, 24.0% and 4.8% had oral cavity, larynx, oropharynx and hypopharynx cancer site respectively (Table 1). Treatment patterns were largely according to guidelines with widespread use of multimodal therapy. Median overall survival was not reached for stage III patients, 59.9 (95%CI:40.1,101.0) and 39.7 (95%CI:20.4, NR) months for stage IVa and IVb respectively, P < 0.01). Factors associated with an increased risk of mortality included advanced stage, older age, the presence of three or more comorbidities, and living in the periphery, whereas higher socioeconomic status was associated with a reduced risk.

CONCLUSION

This real-world analysis shows clinical outcomes comparable to international standards, marked by high adherence to multimodal therapy. Key areas for possible improvement include enhancing early detection by educating primary-care-physicians and addressing the survival gap in peripheral regions.