Geographic Barriers Affect Follow‐Up Care in Head and Neck Cancer

Abstract

Objectives/Hypothesis Follow‐up care in head and neck cancers (HNC) is critical in managing patient health. However, social determinants of health (SDOH) can create difficulties in maintaining follow‐up care. The study goal is to explore how SDOH impacts maintenance of HNC follow‐up care appointments. Methods A systematic retrospective chart review of 877 HNC patients diagnosed in the past 10 years a safety‐net tertiary care hospital with systems to help reduce care disparities. Cohort groups were identified and compared against protocols for follow‐up. Data were analyzed using analysis of variance, chi‐square tests, Fisher's exact tests, two‐sample t‐tests, and simple linear regression. Results The average length of follow‐up time in months and average total number of follow‐ups over 5 years were 32.96 (34.60) and 9.24 (7.87), respectively. There was no significant difference in follow‐up care between United States (US) versus non‐US born and English versus non‐English speaking patients. Race/ethnicity, county median household income, insurance status, and county educational attainment were not associated with differences in follow‐up. However, living a greater distance from the hospital was associated with lower follow‐up length and less frequency in follow‐up (P < .0001). Conclusion While income, primary language, country of birth, race/ethnicity, insurance status, and markers of educational attainment do not appear to impact HNC follow‐up at our safety‐net, tertiary care institution, and distance from hospital remains an important contributor to disparities in care. This study shows that many barriers to care can be addressed in a model that addresses SDOH, but there are barriers that still require additional systems and resources. Laryngoscope, 132:1022–1028, 2022

Racial Disparities in Head and Neck Cancer: It's Not Just About Access

“…Distance from the treating hospital was found to be negatively associated with adherence to follow‐up for HNC care, longer treatment package time, and higher mortality rates 35,42,53,65‐67 . It is important to note that variables such as drive time and travel distance were defined differently among studies and thus, may not be directly comparable.…”

“…Distance from the treating hospital was found to be negatively associated with adherence to follow-up for HNC care, longer treatment package time, and higher mortality rates. 35,42,53,[65][66][67] It is important to note that variables such as drive time and travel distance were defined differently among studies and thus, may not be directly comparable. For example, some studies evaluated drive time while others evaluated public transit time, walking distance, or distance directly from point A to point B (as the crow flies).…”

Socioeconomic disparities in treatment and survival in patients with hypopharyngeal malignancy

“…While there are numerous considerations, little is known about the interplay between clinical factors, access to healthcare, and socioeconomic biases in making these decisions. Prior studies have shown a correlation between outcomes in head and neck cancer and socioeconomic factors such as race, education, geography, and insurance status 4–10 . To date, this is the first study that addresses these social determinants of health (SDoH) and compliance with NCCN guidelines for therapy for this cancer subsite.…”

“…Prior studies have shown a correlation between outcomes in head and neck cancer and socioeconomic factors such as race, education, geography, and insurance status. [4][5][6][7][8][9][10] To date, this is the first study that addresses these social determinants of health (SDoH) and compliance with NCCN guidelines for therapy for this cancer subsite. This is especially important since hypopharyngeal malignancy has the lowest survival rate of all head and neck cancer sites.…”

Feasibility of implementing a supervised telehealth exercise intervention in frail survivors of hematopoietic cell transplantation: a pilot randomized trial

“…To date, exercise-based interventions have largely been medical center-based, which may not be feasible or sustainable for long-term survivors [ 7 – 9 ]. This is especially relevant for survivors who may have geographic constraints or those who are frail and may not be independent enough to travel to the medical center [ 10 – 12 ]. Thus, novel approaches are needed to overcome the limitations of conventional exercise interventions.…”