2508 - Impact of Post-Operative Inpatient Radiation Oncology Consult on Adjuvant Radiotherapy Timing for Head and Neck Cancer in an Appalachian Tertiary Care Center
Presenter(s)
J. C. Knoth1, A. Warden1, P. M. Lilly1, T. Fancy2, S. Najeeb3, T. C. Tenenholz1, P. Pifer1, and D. A. Clump II1; 1Department of Radiation Oncology, West Virginia University School of Medicine, WVU Cancer Institute, Morgantown, WV, 2West Virginia University School of Medicine, WVU Cancer Institute, Department of Otolaryngology, Morgantown, WV, 3West Virginia University School of Medicine, WVU Cancer Institute, Department of Medical Oncology, Morgantown, WV
Purpose/Objective(s):
Adjuvant radiotherapy (PORT) for head and neck (H&N) cancer is recommended when adverse pathological features indicate a higher risk of locoregional failure. Prolonged time to initiation (TTI) and total treatment package time (TPT) of PORT have been associated with inferior outcomes. As a large tertiary referral center, our institution therefore aims for TTI = 42 days and for TPT = 100 days, in accordance with national guidelines. However, multiple barriers exist to routinely meeting these metrics in our patient population, which largely encompasses rural Appalachia. In addition to universal challenges, our institution also faces unique, regional disparities. Population health and socioeconomic factors such as access to multi-disciplinary ancillary services (dental, speech, nutrition, etc.), personal transportation, and distance to nearest comprehensive cancer treatment facility frequently influence the delivery of timely PORT. Thus, in Fall 2024 our institution established a clinical workflow quality improvement (QI) intervention with early radiation oncology (RO) consult in the inpatient, post-operative setting for all patients undergoing resection for H&N cancer. The goal of our study was to evaluate both TTI and TPT compared to pre-intervention. Our hypothesis was that early RO consultation would improve timely delivery of PORT when indicated.Materials/Methods:
Following IRB approval, we retrospectively reviewed patients with mucosal H&N cancer who underwent primary surgical resection and PORT at our institution, excluding cases of re-RT. We compared cohorts pre- and post-QI intervention to analyze differences in TTI and TPT.Results:
A total of 62 patients receiving PORT for mucosal H&N cancer were evaluated (n=26 pre-intervention, n=36 post-intervention). A majority of patients had oral cavity (60%) or oropharynx (27%) cancer. The mean TTI and TPT of PORT were both significantly improved after QI intervention, compared to prior (mean TTI: 44.2 days [IQR: 40.25 – 48] vs. 57.2 days [IQR: 47.8 – 64.3], p<0.0001; mean TPT: 84.5 days [IQR: 78 – 90.75] vs. 102.6 days [IQR: 92.5 – 113.5], p<0.0001). The proportion of patients meeting recommended intervals were also significantly improved with the intervention (TTI: 44.4% vs. 15.4% [OR 4.4, 95CI: 1.31–13.42, p=0.03]; TPT: 94.4% vs. 42.3% [OR 23.2, 95CI: 5.19–107.9, p<0.0001]). There was no significant difference in the mean interval between CT simulation and initiation of PORT between groups (16.3 days vs 15.7 days, p=0.6).Conclusion: In a population where significant barriers in receiving necessary PORT for H&N cancer exist, our institution has found success with a clinical workflow QI intervention, establishing early RO consultation in the inpatient, post-operative setting. This has resulted in delivering timely adjuvant RT with intervals that are more in step with national standards, which ultimately may impact oncologic outcomes in our patients.