Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Program Number: B072
Session Name: Poster Session
Patient-centered Oncology Resources to Minimize Barriers and Delays in Treatment
Naomi C Wang, BA1; Ahn Nguyen, BS1; Antonio Bon Nieves, BS1; Sarah Wagoner, MD1; Emma Rea, PAC, MPH1; Colleen Sommer, PAC1; Uma Ramesh, BA1; Maria Feucht, MD1; Andrés M Bur, MD1; Kiran Kakarala, MD1; Lisa Shnayder, MD1; Kevin Sykes, PhD, MPH2; Chelsea Hamill, MD3; Frank Materia, PhD1; Rohit Nallani, MD1; 1KUMC; 2Baylor Scott & White; 3UNMCImportance: Head and neck cancer (HNC) treatment is complex for patients, particularly for locoregional advanced HNC, which often necessitates reconstructive surgery and post-operative radiotherapy (PORT). Timely initiation of PORT is crucial, but delays remain common. Patient-centered education and resources during 2nd touch visits, an additional appointment between diagnosis and surgery, may help identify and address barriers to care and improve outcomes.
Objective: Assess the impact of a 2nd touch clinic visit intervention on timely treatment initiation and adherence.
Design, Setting, and Participants: This prospective study at a single academic tertiary care center included patients who underwent head and neck reconstructive surgery or total laryngectomy from January 1, 2022 to August 1, 2024 with recommendation of PORT. All patients were offered a 2nd touch visit. Patients received informational handouts pertaining to their treatment timeline, reconstructive surgery, and postoperative care. Potential barriers to care were assessed and any necessary referrals or resources were provided.
Main Outcomes and Measures: Treatment initiation and adherence.
Results: Of the 81 patients included, 40 attended a 2nd touch visit. The cohort was predominantly white (90.1%) and male (64.2%), with a mean age of 63.6 (SD 11.1). There were no significant differences in demographic characteristics between those who did and did not attend a 2nd touch visit. Patients who were current smokers had the lowest attendance, while patients with no smoking history had the highest attendance (27.8% vs. 65.5%, p=0.040). Patients who attended a 2nd touch visit had higher health literacy (16.4 vs. 14.7, p=0.167) and anxiety (56.5 vs. 48.4, p=0.169), though these differences were not significant. UW-QoL scores were marginally higher in attendees (78.5 vs. 72.4, p=0.056), with a significant difference in physical-QoL (87.2 vs. 77.7, p=0.008) but not social-QoL (69.7 vs. 67.5, p=0.567).
Most patients had locally advanced disease (96.3%), with no significant association between disease stage and attendance at the 2nd touch visit. The primary tumor site was the oral cavity in 86.4% of cases, the larynx in 12.3%, and the oropharynx in 1.2%. Patients who attended a 2nd touch visit were significantly more likely to be free-flap recipients (95.0% vs. 78.0%, p=0.048) and less likely to undergo total laryngectomy (5.0% vs. 19.5%, p=0.088). Most patients adhered to the PORT recommendation, with a higher adherance rate amongst 2nd touch attendees (95.0% vs. 80.5%, p=0.088). Though not significant, patients who attended 2nd touch visits showed a reduction in delayed initiation of PORT (57.9% vs. 75.8%, p=0.113).
The barriers identified and resources provided during 2nd touch visits are presented in Figure 1.
Conclusions and Relevance: Proactive education and support may help reduce barriers and minimize loss to follow-up and delays in oncologic treatment. However, many factors that contribute to PORT delays are not controlled for in this study. Further work in a larger population is needed to evaluate the impact of the provided information and resources on HNC treatment outcomes.