3284 - Identifying Sources of Delay to Definitive Chemoradiation for Head and Neck Cancer Patients Evaluated in a Co-Located Multidisciplinary Clinic
Presenter(s)
J. Maaskant1, K. Zhang1, M. Riedel2, M. J. Ryan2, W. A. Stokes3, M. W. McDonald4, J. E. Bates5, A. Jethanandani1, J. S. Remick5, C. Steuer6, D. M. Shin7, N. F. Saba8, M. W. El-Deiry9, and S. Rudra5; 1Emory University School of Medicine, Atlanta, GA, 2Winship Cancer Institute, Atlanta, GA, 3Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, 4Winship Cancer Institute of Emory University, Atlanta, GA, 5Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, 6Emory Winship Cancer Institute, Atlanta, GA, 7Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, 8Emory University, Atlanta, GA, 9Otolaryngology, Winship Cancer Institute of Emory University, Atlanta, GA
Purpose/Objective(s):
Delays to definitive treatment initiation are associated with tumor progression and decreased overall survival in patients with head and neck cancer (HNCA). Our institution evaluates head and neck cancer patients in a co-located multidisciplinary clinic (MDC) to reduce delays in accessing oncology services. This study evaluates the care pathway interval (CPI) for patients receiving definitive chemoradiation at our center to identify areas for improvement.Materials/Methods:
This is a retrospective review of patients treated at a tertiary care medical center from 2022-2024. We included head and neck cancer (HNC) patients treated with definitive concurrent chemoradiation therapy (CRT). Patients were excluded if they received any portion of their care outside of the institution. CPI was defined as time between first visit at MDC and start of radiation therapy (RT). Patients experiencing greater than 30 calendar days were categorized as delayed. We reviewed the electronic medical records of delayed patients to identify and classify sources of delay. Patients with multiple sources of delay were classified based on the perceived most impactful delay. Categories of delay included need for dental extractions, pre-treatment clearance (staging workup, feeding tube placement, etc.), insurance issues, treatment planning/scheduling, holiday-related, and lack of social support. Descriptive statistics were calculated.Results:
247 patients met inclusion criteria. Male patients comprised 83% of our study population. The most common primary cancer sites were oropharynx (75%) and larynx/hypopharynx (17%). From the overall cohort, 41% (n=102) of patients had a CPI greater than 30 days. Median CPI for the overall cohort and for the delayed cohort were 28 days and 40 days, respectively. For the delayed cohort, median time from MDC to RT simulation was 21 days and median time from RT simulation to start of RT was 19 days. The most common sources of delay included pre-treatment clearance (n=29, median CPI of 43 days), treatment planning/scheduling delays (n=23, median CPI of 35 days), need for dental extractions (n=18, median CPI of 46 days), and insurance issues (n=13, median CPI of 37 days).Conclusion:
CPI delays occurred both before and after RT simulation. Delay categories with the largest impact on CPI are dental extractions and pre-treatment clearance. Our clinic has recently incorporated a dental extraction clinic and patient navigation to address these challenges. Improvements in post-RT simulation workflow to address treatment planning and scheduling challenges are areas of opportunities. Understanding CPI metrics is valuable in addressing causes of delays in definitive therapy for patients with HNCA evaluated in a multi-disciplinary clinic.