Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Importance: The increased recognition of the importance of multidisciplinary survivorship care is reflected in the National Cancer Institute’s newly developed national standards. These national standards for survivorship care are particularly relevant in head and neck cancer (HNC) patients, who are especially vulnerable to long-term treatment-related toxicity. However, little is known about this population's patterns and predictors of sustained survivorship clinic attendance.
Objective: This single-center retrospective cohort study aims to determine the clinical and sociodemographic factors associated with sustained survivorship clinic attendance.
Participants: 1,159 HNC patients who attended the UPMC HNC survivorship clinic at least once between Dec 2016 and June 2024.
Main Outcome(s) and Measure(s): Sustained attendance was defined as at least two visits to the UPMC HNC survivorship clinic. Factors of interest include census-block group area deprivation index (ADI), as-the-crow-files distance to survivorship clinic, patient insurance, and cancer site. Factors associated with increased likelihood of sustained attendance were identified using logistic regression.
Results: We found significant differences in clinical and sociodemographic factors between patients who attended survivorship clinic once versus those with sustained attendance. Compared to those with HPV-negative oropharyngeal, hypopharyngeal or laryngeal cancer, the odds of sustained attendance were significantly higher in patients with HPV-positive oropharyngeal cancer (OR = 1.88, 95% CI [1.26, 2.80]). There was no significant difference compared to those with oral cavity (OR 1.06, 95% CI [0.72, 1.58]) or other primary cancer sites (OR = 1.41, 95% CI [0.78, 2.57]). The odds of sustained attendance were significantly lower for patients with unknown insurance status than those with private insurance (OR = 0.33, 95% CI [0.13, 0.78]). The odds of sustained attendance were slightly lower in those with Medicaid/uninsured (OR = 0.81, 95% CI [0.54, 1.21]) or with Medicare (OR = 0.86, CI [0.60, 1.24]) compared to private insurance, but not statistically significant. Compared to patients who live within a 7-mile radius of the HNC survivorship clinic, the odds of sustained attendance were significantly lower for patients who live 17-45 miles (OR = 0.47, 95% CI [0.30, 0.73]) or >45 miles (OR = 0.51, 95% CI [0.32, 0.79]) from the clinic. Compared to ADI <51, we found that patients who live in neighborhoods with ADI 51-69) were significantly less likely to have sustained attendance (OR = 0.64, 95% CI [0.41, 0.99]).
Conclusions and Relevance: These data suggest that patients with HPV-positive oropharyngeal cancer, with private insurance, who live close to clinic, and who live in less socioeconomically deprived neighborhoods are the most likely to have sustained survivorship clinic attendance. While further research is needed to confirm these results and understand the perceived barriers and facilitators to survivorship clinic attendance, these data suggest our current efforts are not reaching the most vulnerable HNC patients.