Assessing the Risk of Adjuvant Radiotherapy Initiation Delays With Social Support Surveys

Abstract

ObjectiveIn 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 DesignProspective cohort study.SettingSingle tertiary medical center.MethodsPatients 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.ResultsA 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).ConclusionSocial support metrics were significantly associated with PORT delays, which may help promote tighter scheduling and closer monitoring of high‐risk patients.

Association of Social-Ecological Factors With Delay in Time to Initiation of Postoperative Radiation Therapy

“…Pilot data from these interventions shows promising improvements in timely PORT initiation, and larger studies are under way to validate these findings . Though not specifically addressed in this study, the Medical Outcomes Study—Social Support Inventory (MOS-SSS) is a measure of social support evaluated in our prior work . Considered an interpersonal-level factor in the social-ecological model, social support has been shown to contribute to resilience through cancer treatment, and has been associated with increased follow-up, decreased travel burden, and improved depressive symptoms and psychological distress associated with physical symptoms .…”

“…For example, the decision to pursue PORT at an outside facility is likely influenced by distance from facility, social support, and access to transportation . Lower baseline social support, health literacy, and access to a main tertiary hospital are later compounded by fragmented coordination between surgical and radiation facilities . Similarly, clinical factors previously associated with PORT delay in head and neck cancer have included stage 4 disease and oral cavity site .…”

Delays Starting Postoperative Radiotherapy Among Head and Neck Cancer Patients: A Systematic Review and Meta‐analysis

“…First, appropriate risk adjustment for observed and expected rates of PORT delay based on institutional case mix is critical to ensure accurate and fair reporting. Delays in starting PORT disproportionately affect patients of black race and Hispanic ethnicity; Medicaid or no insurance; lower levels of education, health literacy, and social support; and those with care fragmentation (usually due to rurality and/or transportation insecurity) 6,66‐68 . Without appropriate risk adjustment, institutions serving medically vulnerable patients could be inappropriately judged as delivering lower‐quality care.…”

“…Delays in starting PORT disproportionately affect patients of black race and Hispanic ethnicity; Medicaid or no insurance; lower levels of education, health literacy, and social support; and those with care fragmentation (usually due to rurality and/or transportation insecurity). 6,[66][67][68] Without appropriate risk adjustment, institutions serving medically vulnerable patients could be inappropriately judged as delivering lower-quality care. Second, variability in performance across institutions and patient populations highlights an opportunity to identify the subpopulations of patients at the highest risk of PORT delay.…”