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Marrero-Gonzalez AR, Graboyes EM. Disparities in Care for Patients with Head and Neck Cancer. Surg Oncol Clin N Am 2024; 33:669-681. [PMID: 39244286 PMCID: PMC11381712 DOI: 10.1016/j.soc.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2024]
Abstract
This article examines disparities in head and neck cancer across the cancer care continuum. It provides a public health lens to understand multilevel determinants of health behavior and the importance of social determinants of health. This article reviews the evidence base showing profound differences in incidence, treatment, and survival for patients with head and neck cancer by race, ethnicity, socioeconomic status, and geography. Continued research is needed to understand and address disparities for patients with head and neck cancer.
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Affiliation(s)
- Alejandro R Marrero-Gonzalez
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC 29425, USA
| | - Evan M Graboyes
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC 29425, USA; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA.
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2
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Duckett KA, Lee BJ, Chera BS, Puram SV, Sandulache VC, Kahmke R, Nguyen SA, Nussenbaum B, Alberg AJ, Halbert CH, Sterba KR, Graboyes EM. Author Reply to Letter by Topkan et al Regarding Delays in Starting Postoperative Radiotherapy. Otolaryngol Head Neck Surg 2024; 171:315-316. [PMID: 38655738 PMCID: PMC11211055 DOI: 10.1002/ohn.769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 02/05/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Kelsey A Duckett
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston , South Carolina, USA
| | - Byung Joo Lee
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston , South Carolina, USA
- Department of Advanced Specialty Sciences, James B. Edwards College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Bhisham S Chera
- Department of Radiation Oncology, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
- Department of Genetics, Washington University School of Medicine, St Louis, Missouri, USA
| | - Vlad C Sandulache
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
- ENT Section, Operative CareLine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Russel Kahmke
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston , South Carolina, USA
| | - Brian Nussenbaum
- American Board of Otolaryngology-Head and Neck Surgery, Houston, Texas, USA
| | - Anthony J Alberg
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, South Carolina, USA
| | - Chanita Hughes Halbert
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Katherine R Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston , South Carolina, USA
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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Duckett KA, Kassir MF, Nguyen SA, Brennan EA, Chera BS, Sterba KR, Halbert CH, Hill EG, McCay J, Puram SV, Jackson RS, Sandulache VC, Kahmke R, Osazuwa-Peters N, Ramadan S, Nussenbaum B, Alberg AJ, Graboyes EM. Factors Associated with Head and Neck Cancer Postoperative Radiotherapy Delays: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2024. [PMID: 38842034 DOI: 10.1002/ohn.835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 05/02/2024] [Accepted: 05/12/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVE Initiating postoperative radiotherapy (PORT) within 6 weeks of surgery for head and neck squamous cell carcinoma (HNSCC) is included in the National Comprehensive Cancer Network Clincal Practice Guidelines and is a Commission on Cancer quality metric. Factors associated with delays in starting PORT have not been systematically described nor synthesized. DATA SOURCES PubMed, Scopus, and CINAHL. REVIEW METHODS We included studies describing demographic characteristics, clinical factors, or social determinants of health associated with PORT delay (>6 weeks) in patients with HNSCC treated in the United States after 2003. Meta-analysis of odds ratios (ORs) was performed on nonoverlapping datasets. RESULTS Of 716 unique abstracts reviewed, 21 studies were included in the systematic review and 15 in the meta-analysis. Study sample size ranged from 19 to 60,776 patients. In the meta-analysis, factors associated with PORT delay included black race (OR, 1.46, 95% confidence interval [CI]: 1.28-1.67), Hispanic ethnicity (OR, 1.37, 95% CI, 1.17-1.60), Medicaid or no health insurance (OR, 2.01, 95% CI, 1.90-2.13), lower income (OR, 1.38, 95% CI, 1.20-1.59), postoperative admission >7 days (OR, 2.92, 95% CI, 2.31-3.67), and 30-day hospital readmission (OR, 1.37, 95% CI, 1.29-1.47). CONCLUSION Patients at greatest risk for a delay in initiating guideline-adherent PORT include those who are from minoritized communities, of lower socioeconomic status, and experience postoperative challenges. These findings provide the foundational evidence needed to deliver targeted interventions to enhance equity and quality in HNSCC care delivery.
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Affiliation(s)
- Kelsey A Duckett
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mohamed Faisal Kassir
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Emily A Brennan
- MUSC Libraries, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Bhisham S Chera
- Department of Radiation Oncology, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Katherine R Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Chanita Hughes Halbert
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Elizabeth G Hill
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jessica McCay
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
- Department of Genetics, Washington University School of Medicine, St Louis, Missouri, USA
| | - Ryan S Jackson
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Vlad C Sandulache
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
- ENT Section, Operative CareLine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Russel Kahmke
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina, USA
| | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina, USA
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Salma Ramadan
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Brian Nussenbaum
- American Board of Otolaryngology-Head and Neck Surgery, Houston, Texas, USA
| | - Anthony J Alberg
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, South Carolina, USA
| | - Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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Graboyes EM, Cagle JL, Ramadan S, Prasad K, Yan F, Pearce J, Mazul AL, Anoma JS, Hill EG, Chera BS, Puram SV, Jackson R, Sandulache VC, Tam S, Topf MC, Kahmke R, Osazuwa-Peters N, Nussenbaum B, Alberg AJ, Sterba KR, Halbert CH. Neighborhood-Level Disadvantage and Delayed Adjuvant Therapy in Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2024; 150:472-482. [PMID: 38662392 PMCID: PMC11046410 DOI: 10.1001/jamaoto.2024.0424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/07/2024] [Indexed: 04/26/2024]
Abstract
Importance For patients with head and neck squamous cell carcinoma (HNSCC), initiation of postoperative radiation therapy (PORT) within 6 weeks of surgery is recommended by the National Comprehensive Cancer Network Guidelines and the Commission on Cancer. Although individual-level measures of socioeconomic status are associated with receipt of timely, guideline-adherent PORT, the role of neighborhood-level disadvantage has not been examined. Objective To characterize the association of neighborhood-level disadvantage with delays in receiving PORT. Design, Setting, and Participants This retrospective cohort study included 681 adult patients with HNSCC undergoing curative-intent surgery and PORT from 2018 to 2020 at 4 US academic medical centers. The data were analyzed between June 21, 2023, and March 5, 2024. Main Outcome Measures and Measures The primary outcome was delay in initiating guideline-adherent PORT (ie, >6 weeks after surgery). Time-to-PORT (TTP) was a secondary outcome. Census block-level Area Deprivation Index (ADI) scores were calculated and reported as national percentiles (0-100); higher scores indicate greater deprivation. The association of ADI scores with PORT delay was assessed using multivariable logistic regression adjusted for demographic, clinical, and institutional characteristics. PORT initiation across ADI score population quartiles was evaluated with cumulative incidence plots and Cox models. Results Among 681 patients with HNSCC undergoing surgery and PORT (mean [SD] age, 61.5 [11.2] years; 487 [71.5%] men, 194 [29.5%] women) the PORT delay rate was 60.8% (414/681) and median (IQR) TTP was 46 (40-56) days. The median (IQR) ADI score was 62.0 (44.0-83.0). Each 25-point increase in ADI score was associated with a corresponding 32% increase in the adjusted odds ratio (aOR) of PORT delay (aOR, 1.32; 95% CI, 1.07-1.63) on multivariable regression adjusted for institution, age, race and ethnicity, insurance, comorbidity, cancer subsite, stage, postoperative complications, care fragmentation, travel distance, and rurality. Increasing ADI score population quartiles were associated with increasing TTP (hazard ratio of PORT initiation, 0.71; 95% CI, 0.53-0.96; 0.59; 95% CI, 0.44-0.77; and 0.54; 95% CI, 0.41-0.72; for ADI quartiles 2, 3, and 4 vs ADI quartile 1, respectively). Conclusions and Relevance Increasing neighborhood-level disadvantage was independently associated with a greater likelihood of PORT delay and longer TTP in a dose-dependent manner. These findings indicate a critical need for the development of multilevel strategies to improve the equitable delivery of timely, guideline-adherent PORT.
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Affiliation(s)
- Evan M. Graboyes
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Joshua Lee Cagle
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Salma Ramadan
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Kavita Prasad
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Flora Yan
- Department of Otolaryngology–Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - John Pearce
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Angela L. Mazul
- Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jean-Sebastien Anoma
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Elizabeth G. Hill
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Bhisham S. Chera
- Hollings Cancer Center, Department of Radiation Oncology, Medical University of South Carolina, Charleston
| | - Sidharth V. Puram
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
- Department of Genetics, Washington University School of Medicine, St Louis, Missouri
| | - Ryan Jackson
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Vlad C. Sandulache
- Bobby R. Alford Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
- ENT Section, Operative CareLine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Samantha Tam
- Department of Otolaryngology–Head and Neck Surgery, Henry Ford Health, Detroit, Michigan
| | - Michael C. Topf
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Russel Kahmke
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina
| | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina
- Deputy Editor, Diversity, Equity, and Inclusion, JAMA Otolaryngology–Head & Neck Surgery
| | - Brian Nussenbaum
- American Board of Otolaryngology–Head and Neck Surgery, Houston, Texas
| | - Anthony J. Alberg
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia
| | - Katherine R. Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Chanita Hughes Halbert
- Department of Population and Public Health Sciences and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles
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Hernández JJC, Arrula VA, Álvarez YE, Castaño AG, de Castro JJG, Docampo LI, Sorrosal JL, Segura PP, Domínguez AR, Campos-Lucas FJ, Rodríguez IS, Bessa M, Gratal P, Caballero-Martínez F, Martín DM, Antón-Rodríguez C, López R. Indicators to evaluate quality of care in head and neck cancer in Spain. Clin Transl Oncol 2024; 26:1089-1097. [PMID: 37848694 PMCID: PMC11026290 DOI: 10.1007/s12094-023-03298-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/25/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE This study aimed to develop a set of criteria and indicators to evaluate the quality of care of patients with head and neck cancer (HNC). METHODS A systematic literature review was conducted to identify valuable criteria/indicators for the assessment of the quality of care in HNC. With the aid of a technical group, a scientific committee of oncologists specialised in HNC used selected criteria to propose indicators that were evaluated with a two-round Delphi method. Indicators on which consensus was achieved were then prioritised by the scientific committee to develop a final set of indicators. RESULTS We proposed a list of 50 indicators used in the literature or developed by us to be evaluated with a Delphi method. There was consensus on the appropriateness of 47 indicators in the first round; the remaining 3 achieved consensus in the second round. The 50 indicators were scored to prioritise them, leading to a final selection of 29 indicators related to structure (3), process (22), or outcome (4) and covering diagnosis, treatment, follow-up, and health outcomes in patients with HNC. Easy-to-use index cards were developed for each indicator, with their criterion, definition, formula for use in real-world clinical practice, rationale, and acceptable level of attainment. CONCLUSIONS We have developed a set of 29 evidence-based and expert-supported indicators for evaluating the quality of care in HNC, covering diagnosis, treatment, follow-up, and health outcomes.
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Affiliation(s)
- Juan Jesús Cruz Hernández
- Departamento de Medicina, Universidad de Salamanca, Consejero Emérito de la Fundación ECO, Campus Universitario Miguel de Unamuno s/n, 37007, Salamanca, Spain.
- Fundación ECO, Madrid, Spain.
| | | | - Yolanda Escobar Álvarez
- Fundación ECO, Madrid, Spain
- Servicio de Oncología Médica, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Almudena García Castaño
- Servicio de Oncología Médica, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | | | - Julio Lambea Sorrosal
- Servicio de Oncología Médica, Hospital Clínico Universitario Lozano Blesa, Saragossa, Spain
| | - Pedro Pérez Segura
- Fundación ECO, Madrid, Spain
- Servicio de Oncología Médica, Hospital Clínico San Carlos, Madrid, Spain
| | - Antonio Rueda Domínguez
- Fundación ECO, Madrid, Spain
- Servicio de Oncología Médica, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | | | | | | | | | | | | | - Rafael López
- Fundación ECO, Madrid, Spain
- Servicio de Oncología Médica, Hospital Clínico Universitario e Instituto de Investigación Sanitaria (IDIS) de Santiago de Compostela, CIBERONC, Santiago de Compostela, Spain
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Duckett KA, Kassir MF, Nguyen SA, Brennan EA, Chera BS, Sterba KR, Hughes Halbert C, Hill EG, McCay J, Puram SV, Sandulache VC, Kahmke R, Ramadan S, Nussenbaum B, Alberg AJ, Graboyes EM. Delays Starting Postoperative Radiotherapy Among Head and Neck Cancer Patients: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2024; 170:320-334. [PMID: 37731255 PMCID: PMC10840985 DOI: 10.1002/ohn.538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/10/2023] [Accepted: 09/02/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE Initiating postoperative radiotherapy (PORT) within 6 weeks (42 days) of surgery is the first and only Commission on Cancer (CoC) approved quality metric for head and neck squamous cell carcinoma (HNSCC). No study has systematically reviewed nor synthesized the literature to establish national benchmarks for delays in starting PORT. DATA SOURCES Following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, we performed a systematic review of PubMed, Scopus, and CINAHL. REVIEW METHODS Studies that described time-to-PORT or PORT delays in patients with HNSCC treated in the United States after 2003 were included. Meta-analysis of proportions and continuous measures was performed on nonoverlapping datasets to examine the pooled frequency of PORT delays and time-to-PORT. RESULTS Thirty-six studies were included in the systematic review and 14 in the meta-analysis. Most studies utilized single-institution (n = 17; 47.2%) or cancer registry (n = 16; 44.4%) data. Twenty-five studies (69.4%) defined PORT delay as >6 weeks after surgery (the definition utilized by the CoC and National Comprehensive Cancer Network Guidelines), whereas 4 (11.1%) defined PORT delay as a time interval other than >6 weeks, and 7 (19.4%) characterized time-to-PORT without defining delay. Meta-analysis revealed that 48.6% (95% confidence interval [CI], 41.4-55.9) of patients started PORT > 6 weeks after surgery. Median and mean time-to-PORT were 45.8 (95% CI, 42.4-51.4 days) and 47.4 days (95% CI, 43.4-51.4 days), respectively. CONCLUSION Delays in initiating guideline-adherent PORT occur in approximately half of patients with HNSCC. These meta-analytic data can be used to set national benchmarks and assess progress in reducing delays.
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Affiliation(s)
- Kelsey A Duckett
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mohamed Faisal Kassir
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Emily A Brennan
- MUSC Libraries, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Bhishamjit S Chera
- Department of Radiation Oncology, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Katherine R Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Chanita Hughes Halbert
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Elizabeth G Hill
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jessica McCay
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
- Department of Genetics, Washington University School of Medicine, St Louis, Missouri, USA
| | - Vlad C Sandulache
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
- ENT Section, Operative CareLine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Russel Kahmke
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina, USA
| | - Salma Ramadan
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Brian Nussenbaum
- American Board of Otolaryngology-Head and Neck Surgery, Houston, Texas, USA
| | - Anthony J Alberg
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, South Carolina, USA
| | - Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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Rosas Herrera AM, Haskins AD, Hanania AN, Jhaveri PM, Chapman CH, Huang Q, Hernandez DJ. Timely delivery of PORT for head and neck squamous cell carcinoma in a county hospital. Laryngoscope Investig Otolaryngol 2024; 9:e1211. [PMID: 38362185 PMCID: PMC10866599 DOI: 10.1002/lio2.1211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/11/2023] [Accepted: 12/21/2023] [Indexed: 02/17/2024] Open
Abstract
Objectives The objective of this study was to compare the rate of post-operative radiation therapy (PORT) initiation within 6 weeks for head and neck squamous cell carcinoma patients treated at a safety net, academic institutio between 2019 and 2021 versus those treated in 2022 after implementation of a new clinical pathway. Methods A retrospective case-control study was performed at a single tertiary care, safety-net, academic institution. Patient demographics, tumor characteristics, dates of surgery, and other treatment dates were collected from the electronic medical record. The time from surgery to PORT was calculated. Patients who started radiation treatment within 42 days of surgery were regarded as having started PORT on time. The demographics, tumor characteristics, and rate of timely PORT for the two cohorts of patients were compared. Results From 2018 to 2021, our rate of PORT initiation within 6 weeks of surgery was 12% (n = 57). In 2022, our rate of timely PORT was 88% (n = 16), p < 0.5. Patient demographics and characteristics were similar with the exception of marital status and use of free-flap reconstruction. The 2022 cohort was more likely to be single (p < 0.5), and all patients underwent free-flap reconstruction in 2022 (p < 0.05). Conclusion Early referrals, frequent communication, and use of a secure registry were the key to the success found by our group despite the socioeconomic challenges of our underserved, safety-net hospital patient population. The changes made at our institution should serve as a template for other institutions seeking to improve the quality of care for their HNSCC patients.
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Affiliation(s)
- Ana Maria Rosas Herrera
- Bobby R. Alford Department of Otolaryngology – Head and Neck SurgeryBaylor College of MedicineHoustonTexasUSA
| | - Angela D. Haskins
- Bobby R. Alford Department of Otolaryngology – Head and Neck SurgeryBaylor College of MedicineHoustonTexasUSA
| | - Alexander N. Hanania
- Department of Radiation Oncology, Dan L. Duncan Cancer CenterBaylor College of MedicineHoustonTexasUSA
| | - Pavan M. Jhaveri
- Department of Radiation Oncology, Dan L. Duncan Cancer CenterBaylor College of MedicineHoustonTexasUSA
| | - Christina H. Chapman
- Department of Radiation Oncology, Dan L. Duncan Cancer CenterBaylor College of MedicineHoustonTexasUSA
| | - Quillan Huang
- Section of Hematology and Oncology, Department of MedicineBaylor College of MedicineHoustonTexasUSA
| | - David J. Hernandez
- Bobby R. Alford Department of Otolaryngology – Head and Neck SurgeryBaylor College of MedicineHoustonTexasUSA
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Dayan G, Bahig H, Fortin B, Filion É, Nguyen-Tan PF, O'Sullivan B, Charpentier D, Soulières D, Gologan O, Nelson K, Létourneau L, Schmittbuhl M, Ayad T, Bissada E, Guertin L, Tabet P, Christopoulos A. Predictors of prolonged treatment time intervals in oral cavity cancer. Oral Oncol 2023; 147:106622. [PMID: 37948896 DOI: 10.1016/j.oraloncology.2023.106622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/26/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES Delays in treatment time intervals have been associated with overall survival in oral cavity squamous cell carcinoma (OCSCC). The aim of this study was to identify bottlenecks leading to prolonged treatment intervals. MATERIAL AND METHODS A retrospective analysis was conducted using a cohort of OCSCC patients who underwent surgery and adjuvant radiation therapy. The endpoints of interest were prolonged treatment intervals. Multivariable logistic regression was used to adjust for patient and tumour characteristics. RESULTS Median diagnosis-to-treatment interval (DTI) and surgery to initiation of postoperative radiation therapy interval (S-PORT) were 39 days (IQR 30-54) and 64 days (IQR 54-66), respectively. Prolonged DTI was associated with older age, worse Charlson Comorbidity index scores and worse T stages. Patients with prolonged DTI had longer times to preoperative imaging reports (25 vs 9 days; P < 0.01). Time to preoperative pathology did not differ. Prolonged S-PORT was associated with longer times to pathology report (28 vs 18 days; P < 0.01), to maxillofacial consult (38 vs 15 days; P < 0.01) and to maxillofacial approval of radiation (50 vs 28 days; P < 0.01). In patients requiring medical oncology consults, those with prolonged S-PORT had longer waiting times until consultation (58 vs 38 days; P = 0.02). Multivariate analysis showed independent predictors of prolonged DTI: time to preoperative imaging; and prolonged S-PORT: time to pathology report, time to maxillofacial consult, and time to medical oncology consult. CONCLUSIONS Strategies targeting these organizational bottlenecks may be effective for shortening treatment time intervals, hence representing potential opportunities for improving oncological outcomes in OCSCC patients.
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Affiliation(s)
- Gabriel Dayan
- Division of Otorhinolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Houda Bahig
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Division of Radio-Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Bernard Fortin
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Division of Radio-Oncology, Hopital Maisonneuve-Rosemont, Université de Montréal, Montreal, Quebec, Canada
| | - Édith Filion
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Division of Radio-Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Phuc-Felix Nguyen-Tan
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Division of Radio-Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Brian O'Sullivan
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Division of Radio-Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Danielle Charpentier
- Department of Medicine, Division of Hematology and Medical Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Denis Soulières
- Department of Medicine, Division of Hematology and Medical Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Olga Gologan
- Department of Pathology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Kristoff Nelson
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Division of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Laurent Létourneau
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Division of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Matthieu Schmittbuhl
- Department of Stomatology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Tareck Ayad
- Division of Otorhinolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Eric Bissada
- Division of Otorhinolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Louis Guertin
- Division of Otorhinolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Paul Tabet
- Division of Otorhinolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Apostolos Christopoulos
- Division of Otorhinolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada.
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Graboyes EM, Chappell M, Duckett KA, Sterba K, Halbert CH, Hill EG, Chera B, McCay J, Puram SV, Ramadan S, Sandulache VC, Kahmke R, Nussenbaum B, Alberg AJ, Paskett ED, Calhoun E. Patient Navigation for Timely, Guideline-Adherent Adjuvant Therapy for Head and Neck Cancer: A National Landscape Analysis. J Natl Compr Canc Netw 2023; 21:1251-1259.e5. [PMID: 38081134 PMCID: PMC10846494 DOI: 10.6004/jnccn.2023.7061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/24/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Aligned with the NCCN Clinical Practice Guidelines in Oncology for Head and Neck Cancers, in November 2021 the Commission on Cancer approved initiation of postoperative radiation therapy (PORT) within 6 weeks of surgery for head and neck cancer (HNC) as its first and only HNC quality metric. Unfortunately, >50% of patients do not commence PORT within 6 weeks, and delays disproportionately burden racial and ethnic minority groups. Although patient navigation (PN) is a potential strategy to improve the delivery of timely, equitable, guideline-adherent PORT, the national landscape of PN for this aspect of care is unknown. MATERIALS AND METHODS From September through November 2022, we conducted a survey of health care organizations that participate in the American Cancer Society National Navigation Roundtable to understand the scope of PN for delivering timely, guideline-adherent PORT for patients with HNC. RESULTS Of the 94 institutions that completed the survey, 89.4% (n=84) reported that at least part of their practice was dedicated to navigating patients with HNC. Sixty-eight percent of the institutions who reported navigating patients with HNC along the continuum (56/83) reported helping them begin PORT. One-third of HNC navigators (32.5%; 27/83) reported tracking the metric for time-to-PORT at their facility. When estimating the timeframe in which the NCCN and Commission on Cancer guidelines recommend commencing PORT, 44.0% (37/84) of HNC navigators correctly stated ≤6 weeks; 71.4% (60/84) reported that they did not know the frequency of delays starting PORT among patients with HNC nationally, and 63.1% (53/84) did not know the frequency of delays at their institution. CONCLUSIONS In this national landscape survey, we identified that PN is already widely used in clinical practice to help patients with HNC start timely, guideline-adherent PORT. To enhance and scale PN within this area and improve the quality and equity of HNC care delivery, organizations could focus on providing better education and support for their navigators as well as specialization in HNC.
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Affiliation(s)
- Evan M. Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Michelle Chappell
- American Cancer Society National Navigation Roundtable, Cincinnati, Ohio
| | - Kelsey A. Duckett
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Katherine Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Chanita Hughes Halbert
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California
| | - Elizabeth G. Hill
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Bhishamjit Chera
- Department of Radiation Oncology, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
| | - Jessica McCay
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Sidharth V. Puram
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
- Department of Genetics, Washington University School of Medicine, St. Louis, Missouri
| | - Salma Ramadan
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Vlad C. Sandulache
- Bobby R. Alford Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
- ENT Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Russel Kahmke
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina
| | - Brian Nussenbaum
- American Board of Otolaryngology - Head and Neck Surgery, Houston, Texas
| | - Anthony J. Alberg
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, South Carolina
| | - Electra D. Paskett
- Division of Population Sciences, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio
- Division of Cancer Prevention Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Elizabeth Calhoun
- Department of Population Health, University of Illinois Chicago, Chicago, Illinois
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10
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Graboyes EM, Yom SS. Treatment Delays in Oral Cavity Cancer-Time, Time, Time, See What's Become of Me. JAMA Otolaryngol Head Neck Surg 2023; 149:969-970. [PMID: 37422843 PMCID: PMC10775417 DOI: 10.1001/jamaoto.2023.1942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Affiliation(s)
- Evan M Graboyes
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Sue S Yom
- Department of Radiation Oncology, University of California, San Francisco
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
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11
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Dayan GS, Bahig H, Johnson-Obaseki S, Eskander A, Hong X, Chandarana S, de Almeida JR, Nichols AC, Hier M, Belzile M, Gaudet M, Dort J, Matthews TW, Hart R, Goldstein DP, Yao CMKL, Hosni A, MacNeil D, Fowler J, Higgins K, Khalil C, Khoury M, Mlynarek AM, Morand G, Sultanem K, Maniakas A, Ayad T, Christopoulos A. Oncologic Significance of Therapeutic Delays in Patients With Oral Cavity Cancer. JAMA Otolaryngol Head Neck Surg 2023; 149:961-969. [PMID: 37422839 PMCID: PMC10331621 DOI: 10.1001/jamaoto.2023.1936] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023]
Abstract
Importance Oral cavity cancer often requires multidisciplinary management, subjecting patients to complex therapeutic trajectories. Prolonged treatment intervals in oral cavity cancer have been associated with poor oncological outcomes, but there has yet to be a study investigating treatment times in Canada. Objective To report treatment delays for patients with oral cavity cancer in Canada and evaluate the outcomes of treatment delays on overall survival. Design, Setting, and Participants This multicenter cohort study was performed at 8 Canadian academic centers from 2005 to 2019. Participants were patients with oral cavity cancer who underwent surgery and adjuvant radiation therapy. Analysis was performed in January 2023. Main Outcomes and Measures Treatment intervals evaluated were surgery to initiation of postoperative radiation therapy interval (S-PORT) and radiation therapy interval (RTI). The exposure variables were prolonged intervals, respectively defined as index S-PORT greater than 42 days and RTI greater than 46 days. Patient demographics, Charlson Comorbidity Index, smoking status, alcohol status, and cancer staging were also considered. Univariate (log rank and Kaplan-Meier) and multivariate (Cox regression) analyses were performed to determine associations with overall survival (OS). Results Overall, 1368 patients were included; median (IQR) age at diagnosis was 61 (54-70) years, and 896 (65%) were men. Median (IQR) S-PORT was 56 (46-68) days, with 1093 (80%) patients waiting greater than 42 days, and median (IQR) RTI was 43 (41-47) days, with 353 (26%) patients having treatment time interval greater than 46 days. There were variations in treatment time intervals between institutions for S-PORT (institution with longest vs shortest median S-PORT, 64 days vs 48 days; η2 = 0.023) and RTI (institution with longest vs shortest median RTI, 44 days vs 40 days; η2 = 0.022). Median follow-up was 34 months. The 3-year OS was 68%. In univariate analysis, patients with prolonged S-PORT had worse survival at 3 years (66% vs 77%; odds ratio 1.75; 95% CI, 1.27-2.42), whereas prolonged RTI (67% vs 69%; odds ratio 1.06; 95% CI, 0.81-1.38) was not associated with OS. Other factors associated with OS were age, Charlson Comorbidity Index, alcohol status, T category, N category, and institution. In the multivariate model, prolonged S-PORT remained independently associated with OS (hazard ratio, 1.39; 95% CI, 1.07-1.80). Conclusions and Relevance In this multicenter cohort study of patients with oral cavity cancer requiring multimodal therapy, initiation of radiation therapy within 42 days from surgery was associated with improved survival. However, in Canada, only a minority completed S-PORT within the recommended time, whereas most had an appropriate RTI. An interinstitution variation existed in terms of treatment time intervals. Institutions should aim to identify reasons for delays in their respective centers, and efforts and resources should be directed toward achieving timely completion of S-PORT.
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Affiliation(s)
- Gabriel S. Dayan
- Division of Otolaryngology–Head and Neck Surgery, Centre Hospitalier de l’Université de Montréal (CHUM), Université de Montéal, Montreal, Quebec, Canada
| | - Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | | | - Antoine Eskander
- Department of Otolaryngology–Head and Neck Surgery, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada
| | - Xinyuan Hong
- Department of Otolaryngology–Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Shamir Chandarana
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - John R. de Almeida
- Department of Otolaryngology–Head and Neck Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Anthony C. Nichols
- Department of Otolaryngology–Head and Neck Surgery, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Michael Hier
- Department of Otolaryngology–Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Mathieu Belzile
- Department of Otolaryngology–Head and Neck Surgery, Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Marc Gaudet
- Department of Radiation Oncology, University of Ottawa, Ottawa, Ontario, Canada
| | - Joseph Dort
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - T. Wayne Matthews
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Robert Hart
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - David P. Goldstein
- Department of Otolaryngology–Head and Neck Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Christopher M. K. L. Yao
- Department of Otolaryngology–Head and Neck Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ali Hosni
- Department of Radiation Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Danielle MacNeil
- Department of Otolaryngology–Head and Neck Surgery, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - James Fowler
- Department of Otolaryngology–Head and Neck Surgery, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Kevin Higgins
- Department of Otolaryngology–Head and Neck Surgery, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada
| | - Carlos Khalil
- Department of Otolaryngology–Head and Neck Surgery, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada
| | - Mark Khoury
- Department of Otolaryngology–Head and Neck Surgery, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada
| | - Alex M. Mlynarek
- Department of Otolaryngology–Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Gregoire Morand
- Department of Otolaryngology–Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Khalil Sultanem
- Department of Radiation Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Anastasios Maniakas
- Department of Head and Neck Surgery, MD Anderson Cancer Center, University of Texas, Houston
| | - Tareck Ayad
- Division of Otolaryngology–Head and Neck Surgery, Centre Hospitalier de l’Université de Montréal (CHUM), Université de Montéal, Montreal, Quebec, Canada
| | - Apostolos Christopoulos
- Division of Otolaryngology–Head and Neck Surgery, Centre Hospitalier de l’Université de Montréal (CHUM), Université de Montéal, Montreal, Quebec, Canada
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12
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Renslo B, Sawaf T, Virgen CG, Farrokhian N, Yu KM, Somani SN, Penn J, Ziegler A, Gan GN, Kakarala K, Shnayder Y, Bur AM, Sykes KJ. Assessing the Risk of Adjuvant Radiotherapy Initiation Delays With Social Support Surveys. Otolaryngol Head Neck Surg 2023; 169:928-937. [PMID: 36939526 PMCID: PMC10688033 DOI: 10.1002/ohn.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/23/2022] [Accepted: 12/29/2022] [Indexed: 01/30/2023]
Abstract
OBJECTIVE In patients with head and neck squamous cell carcinoma (HNSCC), initiating postoperative radiotherapy (PORT) greater than 42 days after surgery is associated with a higher risk of poor survival outcomes. Social support has been shown to modulate behaviors related to care-seeking and treatment adherence. In this study, we sought to determine the relationship between social support metrics and PORT delays. STUDY DESIGN Prospective cohort study. SETTING Single tertiary medical center. METHODS Patients with HNSCC who underwent primary surgical excision requiring PORT were prospectively enrolled. Patient-perceived social support metrics were assessed using the Medical Outcomes Study Social Support Survey (MOS-SSS) at initial presurgical evaluation. Associations with PORT delays were evaluated via univariable and multivariable logistic regression analysis. RESULTS A total of 111 patients met the inclusion criteria for the study. An additional 28 patients were recommended to receive PORT but did not initiate treatment and were included for secondary analysis. All four subscales of the MOS-SSS (positive social interaction, affectionate support, tangible support, and emotional/informational support) were significantly associated with PORT initiation delays on univariable analysis. On multivariable analysis, the overall MOS-SSS score (odds ratio [OR] 2.08, 1.15-4.35, p = .028) was significantly associated with PORT initiation delays. On secondary analysis, lower tangible support was associated with a lack of PORT initiation (OR 1.63, 1.05-2.54, p = .028). CONCLUSION Social support metrics were significantly associated with PORT delays, which may help promote tighter scheduling and closer monitoring of high-risk patients.
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Affiliation(s)
- Bryan Renslo
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Tuleen Sawaf
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Celina G. Virgen
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Nathan Farrokhian
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Katherine M. Yu
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Shaan N. Somani
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Joseph Penn
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Andrea Ziegler
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Gregory N. Gan
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kiran Kakarala
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Yelizaveta Shnayder
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Andrés M. Bur
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kevin J. Sykes
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
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13
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Sun Q, Chen X, Luo H, Meng C, Zhu D. Cancer stem cells of head and neck squamous cell carcinoma; distance towards clinical application; a systematic review of literature. Am J Cancer Res 2023; 13:4315-4345. [PMID: 37818051 PMCID: PMC10560931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 08/16/2023] [Indexed: 10/12/2023] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is the major pathological type of head and neck cancer (HNC). The disease ranks sixth among the most common malignancies worldwide, with an increasing incidence rate yearly. Despite the development of therapy, the prognosis of HNSCC remains unsatisfactory, which may be attributed to the resistance to traditional radio-chemotherapy, relapse, and metastasis. To improve the diagnosis and treatment, the targeted therapy for HNSCC may be successful as that for some other tumors. Nanocarriers are the most effective system to deliver the anti-cancerous agent at the site of interest using passive or active targeting approaches. The system enhances the drug concentration in HCN target cells, increases retention, and reduces toxicity to normal cells. Among the different techniques in nanotechnology, quantum dots (QDs) possess multiple fluorescent colors emissions under single-source excitation and size-tunable light emission. Dendrimers are the most attractive nanocarriers, which possess the desired properties of drug retention, release, unaffecting by the immune system, blood circulation time enhancing, and cells or organs specific targeting properties. In this review, we have discussed the up-to-date knowledge of the Cancer Stem Cells of Head and Neck Squamous Cell Carcinoma. Although a lot of data is available, still much more efforts remain to be made to improve the treatment of HNSCC.
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Affiliation(s)
- Qingjia Sun
- Department of Otorhinolaryngology, Head and Neck Surgery, The China-Japan Union Hospital of Jilin UniversityXiantai Street 126, Changchun 130033, Jilin, China
| | - Xi Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, The China-Japan Union Hospital of Jilin UniversityXiantai Street 126, Changchun 130033, Jilin, China
| | - Hong Luo
- Department of Hematology, The First Hospital of QiqiharQiqihar 161005, Heilongjiang, China
| | - Cuida Meng
- Department of Otorhinolaryngology, Head and Neck Surgery, The China-Japan Union Hospital of Jilin UniversityXiantai Street 126, Changchun 130033, Jilin, China
| | - Dongdong Zhu
- Department of Otorhinolaryngology, Head and Neck Surgery, The China-Japan Union Hospital of Jilin UniversityXiantai Street 126, Changchun 130033, Jilin, China
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14
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Lorenz FJ, Mahase SS, Miccio J, King TS, Pradhan S, Goyal N. Update on adherence to guidelines for time to initiation of postoperative radiation for head and neck squamous cell carcinoma. Head Neck 2023; 45:1676-1691. [PMID: 37102787 PMCID: PMC10797635 DOI: 10.1002/hed.27380] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 03/28/2023] [Accepted: 04/16/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND A prior study reported that over half of patients with HNSCC initiated PORT after 6 weeks from surgery during 2006-2014. In 2022, the CoC released a quality metric for patients to initiate PORT within 6 weeks. This study provides an update on time to PORT in recent years. METHODS The NCDB and TriNetX Research Network were queried to identify patients with HNSCC who received PORT during 2015-2019 and 2015-2021, respectively. Treatment delay was defined as initiating PORT beyond 6 weeks after surgery. RESULTS In NCDB, PORT was delayed for 62% of patients. Predictors of delay included age >50, female sex, black race, nonprivate insurance/uninsured status, lower education, oral cavity site, negative surgical margins, increased postoperative length of stay, unplanned hospital readmissions, IMRT radiation modality, treatment at an academic hospital or in the Northeast, and surgery and radiation at different facilities. In TriNetX, 64% experienced treatment delay. Additional associations with prolonged time to treatment included never married/divorced/widowed marital status, major surgery (neck dissection/free flaps/laryngectomy), and gastrostomy/tracheostomy dependence. CONCLUSIONS There continue to be challenges to timely initiation of PORT.
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Affiliation(s)
- F. Jeffrey Lorenz
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Sean S. Mahase
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
- Department of Radiation Oncology, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Joseph Miccio
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
- Department of Radiation Oncology, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Tonya S. King
- Department of Public Health Sciences, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Sandeep Pradhan
- Department of Public Health Sciences, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Neerav Goyal
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
- Department of Public Health Sciences, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
- Department of Otolaryngology – Head and Neck Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
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15
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Sawaf T, Virgen CG, Renslo B, Farrokhian N, Yu KM, Somani SN, Bur AM, Kakarala K, Shnayder Y, Gan GN, Graboyes EM, Sykes KJ. Association of Social-Ecological Factors With Delay in Time to Initiation of Postoperative Radiation Therapy: A Prospective Cohort Study. JAMA Otolaryngol Head Neck Surg 2023; 149:477-484. [PMID: 37079327 PMCID: PMC10119772 DOI: 10.1001/jamaoto.2023.0308] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 02/14/2023] [Indexed: 04/21/2023]
Abstract
Importance Timely initiation of postoperative radiation therapy (PORT) is associated with reduced recurrence rates and improved overall survival in patients with head and neck squamous cell carcinoma (HNSCC). Measurement of the association of social-ecological variables with PORT delays is lacking. Objective To assess individual and community-level factors associated with PORT delay among patients with HNSCC. Design, Setting, and Participants This prospective cohort study carried out between September 2018 and June 2022 included adults with untreated HNSCC who were enrolled in a prospective registry at a single academic tertiary medical center. Demographic information and validated self-reported measures of health literacy were obtained at baseline visits. Clinical data were recorded, and participant addresses were used to calculate the area deprivation index (ADI), a measure of community-level social vulnerability. Participants receiving primary surgery and PORT were analyzed. Univariable and multivariable regression analysis was performed to identify risk factors for PORT delays. Exposures Surgical treatment and PORT. Main Outcomes and Measures The primary outcome was PORT initiation delay (>42 days from surgery). Risk of PORT initiation delay was evaluated using individual-level (demographic, health literacy, and clinical data) and community-level information (ADI and rural-urban continuum codes). Results Of 171 patients, 104 patients (60.8%) had PORT delays. Mean (SD) age of participants was 61.0 (11.2) years, 161 were White (94.2%), and 105 were men (61.4%). Insurance was employer-based or public among 65 (38.5%) and 75 (44.4%) participants, respectively. Mean (SD) ADI (national percentile) was 60.2 (24.4), and 71 (41.8%) resided in rural communities. Tumor sites were most commonly oral cavity (123 [71.9%]), with 108 (63.5%) classified as stage 4 at presentation. On multivariable analysis, a model incorporating individual-level factors with health literacy in addition to community-level factors was most predictive of PORT delay (AOC= 0.78; R2, 0.18). Conclusions and Relevance This cohort study provides a more comprehensive assessment of predictors of PORT delays that include health literacy and community-level measures. Predictive models that incorporate multilevel measures outperform models with individual-level factors alone and may guide precise interventions to decrease PORT delay for at-risk patients with HNSCC.
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Affiliation(s)
- Tuleen Sawaf
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
| | - Celina G. Virgen
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
| | - Bryan Renslo
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
| | - Nathan Farrokhian
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
| | - Katherine M. Yu
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
| | - Shaan N. Somani
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
| | - Andrés M. Bur
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
| | - Kiran Kakarala
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
| | - Yelizaveta Shnayder
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
| | - Gregory N. Gan
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City
| | - Evan M. Graboyes
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Kevin J. Sykes
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
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Philteos J, Noel CW, Hallet J, Eskander A. Mental health considerations in patients undergoing complex head and neck reconstruction. Curr Opin Otolaryngol Head Neck Surg 2022; 30:380-383. [PMID: 35924661 DOI: 10.1097/moo.0000000000000827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To summarize recent advances in the psycho-oncology literature, with a focus on findings relevant to the head and neck cancer patient. RECENT FINDINGS Patients with cancer are at an increased risk of suicide and self-harm. Head and neck cancer patients are among the highest risk compared with other cancer patients. Unique challenges pertaining to disfigurement and voicelessness may, in part, explain these observations. Patient-reported outcome measures can be used to help identify high-risk patients. SUMMARY Psychosocial support needs are highest for head and neck cancer patients. Patient-reported outcome measures should be integrated within clinical workflows to identify high-risk patients.
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Affiliation(s)
- Justine Philteos
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre and Michael Garron Hospital
| | - Christopher W Noel
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre and Michael Garron Hospital.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto
| | - Jullie Hallet
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto.,Division of Surgical Oncology, Odette Cancer Centre-Sunnybrook Health Sciences Centre, Toronto, Ontario.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre and Michael Garron Hospital.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto
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17
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Marwah R, Goonetilleke D, Smith J, Chilkuri M. Evaluating delays in patients treated with post-operative radiation therapy for head and neck squamous cell carcinoma. J Med Imaging Radiat Oncol 2022; 66:840-846. [PMID: 35726770 PMCID: PMC9544161 DOI: 10.1111/1754-9485.13449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/07/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Delays in commencing post-operative radiation therapy (PORT) and prolongation of overall treatment times (OTT) are associated with reduced overall survival and higher recurrence rates in patients with head and neck squamous cell carcinoma (HNSCC). The objective of this study was to evaluate treatment delays, factors contributing to those delays and to explore strategies to mitigate them. METHODS This retrospective study included patients with mucosal HNSCC at Townsville University Hospital treated with curative intent surgery and PORT between June 2011 and June 2019. The proportion of patients who experienced delays in commencing PORT (>6 weeks) and OTT were evaluated and reasons for these delays were explored. RESULTS The study included 94 patients of which 70% experienced PORT delay. Surgery at an external facility (81% vs 56%, P = 0.006) and longer post-operative length of stay (P = 0.011) were significantly associated with a higher incidence of PORT delay. Aboriginal and Torres Strait Islander patients had a higher rate of PORT delay (89% vs 68.2%, P = 0.198). Significant delays were noted from time of surgery to radiation oncology (RO) consult and from RO consult to commencement of radiation treatment. CONCLUSION This study demonstrates that the prevalence of PORT delay for patients with HNSCC remains high with room for improvement. Potential strategies to improve delays include developing effective care coordination, addressing specific needs of Indigenous patients, implementing reliable automated tracking and communication systems between teams and harnessing existing electronic referral systems.
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Affiliation(s)
- Ravi Marwah
- Townsville University HospitalTownsvilleQueenslandAustralia
| | | | - Justin Smith
- Townsville University HospitalTownsvilleQueenslandAustralia
- James Cook UniversityTownsvilleQueenslandAustralia
| | - Madhavi Chilkuri
- Townsville University HospitalTownsvilleQueenslandAustralia
- James Cook UniversityTownsvilleQueenslandAustralia
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18
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Graboyes EM, Divi V, Moore BA. Head and Neck Oncology Is on the National Quality Sidelines No Longer-Put Me in, Coach. JAMA Otolaryngol Head Neck Surg 2022; 148:715-716. [PMID: 35708673 PMCID: PMC9378525 DOI: 10.1001/jamaoto.2022.1389] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Evan M Graboyes
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina.,Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Vasu Divi
- Department of Otolaryngology-Head & Neck Surgery, Stanford University, Stanford, California
| | - Brian A Moore
- Department of Otorhinolaryngology and Communication Sciences, Ochsner Health, New Orleans, Louisiana.,Ochsner Cancer Institute, New Orleans, Louisiana
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19
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Noyes EA, Burks CA, Larson AR, Deschler DG. An equity-based narrative review of barriers to timely postoperative radiation therapy for patients with head and neck squamous cell carcinoma. Laryngoscope Investig Otolaryngol 2021; 6:1358-1366. [PMID: 34938875 PMCID: PMC8665479 DOI: 10.1002/lio2.692] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 10/15/2021] [Accepted: 10/25/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The majority of patients with head and neck squamous cell carcinoma (HNSCC) do not commence postoperative radiation treatment (PORT) within the recommended 6 weeks. We explore how delayed PORT affects survival outcomes, what factors are associated with delayed PORT initiation, and what interventions exist to reduce delays in PORT initiation. METHODS We conducted a PubMed search to identify articles discussing timely PORT for HNSCC. We performed a narrative review to assess survival outcomes of delayed PORT as well as social determinants of health (SDOH) and clinical factors associated with delayed PORT, using the PROGRESS-Plus health equity framework to guide our analysis. We reviewed interventions designed to reduce delays in PORT. RESULTS Delayed PORT is associated with reduced overall survival. Delays in PORT disproportionately burden patients of racial/ethnic minority backgrounds, Medicaid or no insurance, low socioeconomic status, limited access to care, more comorbidities, presentation at advanced stages, and those who experience postoperative complications. Delays in PORT initiation tend to occur during transitions in head and neck cancer care. Delays in PORT may be reduced by interventions that identify patients who are most likely to experience delayed PORT, support patients according to their specific needs and barriers to care, and streamline care and referral processes. CONCLUSIONS Both SDOH and clinical factors are associated with delays in timely PORT. Structural change is needed to reduce health disparities and promote equitable access to care for all. When planning care, providers must consider not only biological factors but also SDOH to maximize care outcomes.
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Affiliation(s)
| | - Ciersten A. Burks
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and EarHarvard Medical SchoolBostonMassachusettsUSA
| | - Andrew R. Larson
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and EarHarvard Medical SchoolBostonMassachusettsUSA
| | - Daniel G. Deschler
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and EarHarvard Medical SchoolBostonMassachusettsUSA
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