Clinician Attitudes and Beliefs About Deintensifying Head and Neck Cancer Surveillance

Abstract

Surveillance imaging and visits are costly and have not been shown to improve oncologic outcomes for patients with head and neck cancer (HNC). However, the benefit of surveillance visits may extend beyond recurrence detection. To better understand surveillance and potentially develop protocols to tailor current surveillance paradigms, it is important to elicit the perspectives of the clinicians who care for patients with HNC. OBJECTIVE To characterize current surveillance practices and explore clinician attitudes and beliefs on deintensifying surveillance for patients with HNC.DESIGN, SETTING, AND PARTICIPANTS This qualitative study was performed from January to March 2021. Guided by an interpretive description approach, interviews were analyzed to produce a thematic description. Data analysis was performed from March to April 2021. Otolaryngologists and radiation oncologists were recruited using purposive and snowball sampling strategies. MAIN OUTCOMES AND MEASURESThe main outcomes were current practice, attitudes, and beliefs about deintensifying surveillance and survivorship as well as patients' values and perspectives collected from interviews of participating physicians.RESULTS Twenty-one physicians (17 [81%] men) were interviewed, including 13 otolaryngologists and 8 radiation oncologists with a median of 8 years (IQR, 5-20 years) in practice. Twelve participants (57%) stated their practice comprised more than 75% of patients with HNC. Participants expressed that there was substantial variation in the interpretation of the surveillance guidelines. Participants were open to the potential for deintensification of surveillance or incorporating symptom-based surveillance protocols but had concerns that deintensification may increase patient anxiety and shift some of the burden of recurrence monitoring to patients. Patient and physician peace of mind, the importance of maintaining the patient-physician relationship, and the need for adequate survivorship and management of treatment-associated toxic effects were reported to be important barriers to deintensifying surveillance. CONCLUSIONS AND RELEVANCEIn this qualitative study, clinicians revealed a willingness to consider altering cancer surveillance but expressed a need to maintain patient and clinician peace of mind, maintain the patient-clinician relationship, and ensure adequate monitoring of treatment-associated toxic effects and other survivorship concerns. These findings may be useful in future research on the management of posttreatment surveillance.

Routine follow‐up care for head and neck cancer after curative treatment: A 3‐year experience of measuring patients' self‐reported needs, preferences, quality of life and attitudes towards follow‐up

“…Given that the frequency of visits decreases over time in follow‐up care, one might think that a patient's needs, fears and anxieties would decrease to correspond with less visits. A recent qualitative study demonstrated that physicians do believe that patients have ongoing requirements throughout the follow‐up period (Chen et al, 2021). Our work confirmed this and quantifies these requirements from a patient perspective.…”

Surviving Surveillance—Are Current Head and Neck Cancer Posttreatment Surveillance Recommendations Better for Patients or Ourselves?

“…Conversely, physicians reported low-risk disease as being a facilitator for lengthening follow-up intervals. 1 We would argue the contrary. It is well established that patients with advanced initial-stage disease, especially if coupled with a short disease-free interval, will have extremely poor salvage treatment outcomes.…”

“…As more patients with head and neck cancer benefit from a quantity-of-life perspective from more advanced radiation delivery systems, chemoimmunotherapy breakthroughs, and improved surgical techniques, the impending impact this has on resources needed in surveillance, such as costs associated with specialty examinations and anatomic imaging studies, as well as the psychosocial and financial impact on the patients themselves, is becoming more prevalent. In the Original Investigation by Chen et al, 1 the authors seek to identify physician and patientrelated barriers to deintensifying surveillance practices and provide suggestions on facilitating change.…”

“…An intriguing and immensely important distinction made by the authors in their discussion of posttreatment follow-up is the concept of surveillance and survivorship. 1 Tradition-ally, the premise of having a patient undergo frequent surveillance has been to identify recurrence as early as possible to implement salvage treatment and ultimately transition the patient to survivorship status. Indeed, in the authors' interviews of physicians managing patients with head and neck cancer, a patient-level barrier to deintensifying surveillance was the desire to more closely follow up high-risk/high-stage disease.…”

“…An intriguing and immensely important distinction made by the authors in their discussion of posttreatment follow-up is the concept of surveillance and survivorship . Traditionally, the premise of having a patient undergo frequent surveillance has been to identify recurrence as early as possible to implement salvage treatment and ultimately transition the patient to survivorship status.…”