What is the hold up?—Mixed‐methods analysis of postoperative radiotherapy delay in head and neck cancer

Abstract

Background Delays in postoperative radiotherapy (PORT) for head and neck cancer (HNC) increase the risk for recurrence and mortality. The multifactorial nature of delays calls for an in‐depth understanding of potential contributors from the patient's and provider's perspectives. We sought to identify causes of delays in adjuvant radiotherapy initiation for HNC. Methods We performed a mixed‐methods study including patients with HNC care team members. Forty in‐depth interviews were performed (26 patients; 14 care team members). Timing and demographic data were collected from medical records. Results Median time from surgery to radiotherapy initiation was 45 days; 15 participants began after 42 days. Process delays and failure to communicate the urgency and significance of PORT initiation contributes to delays. Patients with a strong social support system experience less delays. Conclusions Achieving reductions in PORT initiation requires efficient care coordination, improved communication between interdisciplinary teams, and strengthening social support systems for patients with HNC.

Postoperative Radiation Therapy Refusal in Human Papillomavirus‐Associated Oropharyngeal Squamous Cell Carcinoma

“…First, the NCDB does not provide clarification regarding the reasons why patients opt to refuse PORT. While these reasons are likely multifactorial in nature, research has shown that delays in adjuvant therapy may be due to lapses in patient–physician communication, inefficiencies in care coordination, or weak social support for patients 52 . An understanding of these determinants could more clearly inform physician behavior and practice modifications.…”

Quality improvement intervention to reduce time to postoperative radiation in head and neck free flap patients

“…The PN established a direct channel between patients, providers, and radiation therapy schedulers. Skyes et al identified a lack of ability to map patients in the multimodality treatment process in real time as a principal contributor to decreased PORT adherence 17 . The insertion of a PN into this expanded role in our institutional workflow served as a common denominator and central hub of communication to ease the burden of coordination from the patients and providers.…”

Barriers to Comprehensive Multidisciplinary Head and Neck Care in a Community Oncology Practice

“…13 Analyses by various groups identify travel/transportation issues as a major cause of patients not receiving guidelineadherent radiotherapy in head and neck cancers. 14,15 In a comprehensive root cause analysis of radiotherapy initiation timing in postoperative radiotherapy in head and neck cancers, multiple factors were identified related to communication, process, and social support. Specifically identified in the social support area was the lack of transportation support as a cause of increased time to initiation of postoperative radiotherapy.…”

“…Specifically identified in the social support area was the lack of transportation support as a cause of increased time to initiation of postoperative radiotherapy. 15 Delays in receiving postoperative radiotherapy are known to negatively impact overall survival in head and neck squamous cell carcinomas. [14][15][16] Solution Employ a head and neck nurse navigator.…”

“…15 Delays in receiving postoperative radiotherapy are known to negatively impact overall survival in head and neck squamous cell carcinomas. [14][15][16] Solution Employ a head and neck nurse navigator. These can be helpful in coordination between offices.…”