Patient Navigation for Timely, Guideline-Adherent Adjuvant Therapy for Head and Neck Cancer: A National Landscape Analysis

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.

The Maze of Head and Neck Cancer Care−Finding Our Way to Successful Patient Navigation

“…Patient navigation programs have been implemented globally and in the US to help patients with cancer to navigate the health care system. 3,9 These programs provide support and advocacy at every step of the patient's journey. Although these initiatives can help to coordinate better patient care, they may not necessarily improve overall survival among patients who have already presented late due to factors outside of their control.…”

“…Managing cancer care for patients with HNC and their families is challenging due to various obstacles, including delays in HNC referrals, diagnosis, treatment initiation, and postoperative radiation treatment delays, which are the only quality metric in head and neck oncology. 3 There is so much to learn about the barriers to and facilitators of timely HNC identified by Batool et al 2 A salient lesson from their study is the important role that nonotolaryngology clinicians (ie, dentists and primary care practitioners [PCPs]) have in the early diagnosis of HNC. Given that a universally approved method for screening asymptomatic individuals is lacking, dentists and PCPs are often the first to detect HNC-during routine checkups or when patients present with suggestive lesions.…”

“…Batool et al assessed how fragmented care affected patients who were receiving multidisciplinary treatment for HNC. Managing cancer care for patients with HNC and their families is challenging due to various obstacles, including delays in HNC referrals, diagnosis, treatment initiation, and postoperative radiation treatment delays, which are the only quality metric in head and neck oncology …”

“…Most HNC programs may already have the necessary glue, but it is underrecognized and underutilized. Patient navigation programs have been implemented globally and in the US to help patients with cancer to navigate the health care system . These programs provide support and advocacy at every step of the patient’s journey.…”