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Program Number: B074
Session Name: Poster Session

Use of Co-located Multidisciplinary Clinic Improves Timeliness to Post-Operative Adjuvant Therapy in Head and Neck Cancer patients

Georges E Daoud, MD¹; Melissa F Riedel, MPH, ODSC¹; Soumon Rudra, MD²; Martha J Ryan, MSN, FNPC¹; Mitesh P Mehta, MD¹; Brian J Boyce, MD¹; Mark W El-Deiry, MD¹; ¹Winship Cancer Institute of Emory University, Department of Otolaryngology-Head and Neck Surgery; ²Winship Cancer Institute of Emory University, Department of Radiation Oncology

Background: Delays in post-operative radiation therapy (PORT) for patients with a diagnosis of head and neck cancer (HNC) is associated with decreased survival, decreased locoregional control, and increased risk of recurrence. Timely initiation of PORT, defined as starting adjuvant RT within 42 days of primary surgical resection, is now recommended by national and international guidelines and is a quality measure endorsed by the Commission on Cancer (CoC). Despite efforts to ensure timely PORT, studies have revealed that 55% – 70% of patients do not meet this goal. This study reports on the use of a co-located multidisciplinary clinic (MDC) to improve the timeliness of post-operative adjuvant therapy.

Methods: Data was prospectively collected and retrospectively reviewed. All patients were treated at a tertiary care medical center and met inclusion criteria if they were treated with primary surgical resection for HNC and subsequently received PORT or post-operative chemoradiation therapy (POCRT). Patients were divided into three time periods: patients treated prior to MDC initiation (pre-MDC, n=55), after MDC initiation (post-MDC, n=74), and after MDC initiation with the addition of a dentist in the clinic (post-MDCD, n=72). Descriptive statistics and univariate analyses with unpaired T-tests and one-way ANOVA were calculated.

Results: 201 patients met inclusion criteria. PORT was recommended for 65.2% (n=131) and POCRT was recommended for 34.8% (n=70). Of pre-MDC patients, 72.7% (n=40) experienced identifiable delays in starting PORT or POCRT, while only 54.1% (n=40) and 41.7% (n=30) of patients experienced delays in the post-MDC and post-MDCD groups, respectively (Figure 1). The remaining patients (pre-MDC, n=15; post-MDC, n=34; post-MDCD, n=42) had no delay or undocumented or unidentified delays that may or may not have limited the timeliness to PORT. Median number of days between surgical resection to adjuvant therapy initiation in the pre-MDC group was 51 days; both the post-MDC and post-MDCD groups saw an improvement in this metric to median of 43 days and 42 days, respectively (p-value <0.001). Moreover, in the pre-MDC cohort, only 27.2% (n=15) of patients adhered to the CoC guideline for adjuvant timeliness, with an improvement to 44.6% (n=33) and 54.2% (n=39) in the post-MDC and post-MDCD cohorts, respectively (Table 1).

Conclusion: Establishing a co-located MDC for patients with HNC enhanced the timeliness of adjuvant treatment initiation at our institution, ensuring better adherence to CoC guidelines. This integrated approach also helps identify and address potential delays in care by emphasizing the roles of essential support staff, such as social workers, speech pathologists, and nutritionists. A co-located MDC thus fosters streamlined communication across multiple disciplines, enabling the development of comprehensive treatment plans in a timely manner which may ultimately improve patient outcomes.

 

 

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