Initial Experience of a Patient Navigation Model for Head and Neck Cancer

Ohlstein, Jason F; Brody-Camp, Sabrina; Friedman, S.H.; Levy, Joshua M.; Buell, Joseph F.; Friedlander, Paul L.

doi:10.1001/jamaoto.2015.1467

Cited by 12 publications

(34 citation statements)

References 19 publications

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“…25,26 Other potential solutions might include increased centralization of care at large health systems to avoid delays related to care transitions and patient navigation programs with a focus on vulnerable populations for whom lack of social support, poor health literacy, or limited access to transportation are likely important barriers to timely treatment. 27,28 We found a significant interaction of DTS and HPV status. In patients with HPV-negative tumors, a DTS ≥ 11 days (the optimal predictive threshold for patients with HPV-negative tumors) led to a more than 1.5-fold increase in the risk of mortality; however, rising DTS had no significant effect on survival in HPV-positive tumors.…”

Section: Discussionmentioning

confidence: 64%

“…With this program, they demonstrated a reduction in time from referral to final diagnosis of 24 days to 7‐10 days and showed that more than 95% of surgically treated patients underwent operation within 28 days of the initial presenting visit . Other potential solutions might include increased centralization of care at large health systems to avoid delays related to care transitions and patient navigation programs with a focus on vulnerable populations for whom lack of social support, poor health literacy, or limited access to transportation are likely important barriers to timely treatment …”

Section: Discussionmentioning

confidence: 99%

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Survival impact of treatment delays in surgically managed oropharyngeal cancer and the role of human papillomavirus status

et al. 2019

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Background The impact of treatment delays on survival in oropharyngeal cancer and whether the effect varies by human papillomavirus (HPV) status have yet to be defined. Methods Retrospective analysis of the survival impact of time from diagnosis to surgery (DTS), surgery to radiation (SRT), and duration of radiation (RTD) for patients in the National Cancer Database with resected oropharyngeal cancer who underwent adjuvant radiation from 2010 to 2014. Results We identified optimal thresholds of 30, 40, and 51 days for DTS, SRT, and RTD, respectively, with treatment times exceeding these thresholds associated with significantly worse overall survival. Prolonged SRT and RTD were associated with mortality regardless of HPV status, although rising DTS was only predictive among patients with HPV‐negative tumors. Conclusions Treatment delays significantly impact survival in oropharyngeal cancer. The consequences of prolonged DTS may be stronger in HPV‐negative than HPV‐positive disease. These data serve as a foundation for future research and clinical management.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Survival impact of treatment delays in surgically managed oropharyngeal cancer and the role of human papillomavirus status

et al. 2019

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“…41–44 However, there is a dearth of data about the association of patient navigation with timely initiation of treatment for patients with HNC. 45,46 Whether patient navigation can decrease delays initiating treatment for HNC is a question that merits further research.…”

Section: Discussionmentioning

confidence: 99%

Association of Treatment Delays With Survival for Patients With Head and Neck Cancer

Graboyes

Kompelli

Neskey

et al. 2019

JAMA Otolaryngol Head Neck Surg

224

313

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IMPORTANCE Delays in the delivery of care for head and neck cancer (HNC) are a key driver of poor oncologic outcomes and thus represent an important therapeutic target. OBJECTIVE To synthesize information about the association between delays in the delivery of care for HNC and oncologic outcomes. EVIDENCE REVIEW A systematic review of the English-language literature in PubMed/MEDLINE and Scopus published between January 1, 2007, and February 28, 2018, was performed to identify articles addressing the association between treatment delays and oncologic outcomes for patients with HNC. Articles that were included (1) addressed cancer of the oral cavity, oropharynx, hypopharynx, or larynx; (2) discussed patients treated in 2004 or later; (3) analyzed time of diagnosis to treatment initiation (DTI), time from surgery to the initiation of postoperative radiotherapy, and/or treatment package time (TPT; the time from surgery through the completion of postoperative radiotherapy); (4) included a clear definition of treatment delay; and (5) analyzed the association between the treatment time interval and an oncologic outcome measure. Quality assessment was performed using the Institute of Health Economics Quality Appraisal Checklist for Case Series Studies. FINDINGS A total of 18 studies met inclusion criteria and formed the basis of the systematic review. Nine studies used the National Cancer Database and 6 studies were single-institution retrospective reviews. Of the 13 studies assessing DTI, 9 found an association between longer DTI and poorer overall survival; proposed DTI delay thresholds ranged from more than 20 days to 120 days or more. Four of the 5 studies assessing time from surgery to the initiation of postoperative radiotherapy (and all 4 studies assessing guideline-adherent time to postoperative radiotherapy) found an association between a timely progression from surgery to the initiation of postoperative radiotherapy and improved overall or recurrence-free survival. Of the 5 studies examining TPT, 4 found that prolonged TPT correlated with poorer overall survival; proposed thresholds for prolonged TPT ranged from 77 days or more to more than 100 days. CONCLUSIONS AND RELEVANCE Timely care regarding initiation of treatment, postoperative radiotherapy, and TPT is associated with survival for patients with HNC, although significant heterogeneity exists for defining delayed DTI and TPT. Further research is required to standardize optimal time goals, identify barriers to timely care for each interval, and design interventions to minimize delays.

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“…The Brazilian Authority enacted a law in 2012 which specifies a maximum period of 60 days from diagnosis to treatment for cancer patients [6]. In the United States, a patient navigation model for head and neck cancer patients has been proposed to decrease the interval period between presentation to a clinic and treatment [25]. Since April 2013, Taiwan’s Ministry of Health and Welfare has subsidized hospitals which have implemented ‘‘MDT management for cancer patients” in order to improve the quality of cancer diagnosis and management [10].…”

Section: Discussionmentioning

confidence: 99%

Influence of time interval from diagnosis to treatment on survival for oral cavity cancer: A nationwide cohort study

et al. 2017

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ObjectivesWe aimed to explore the relationship between the time interval from diagnosis to treatment and survival of oral cavity squamous cell carcinoma patients.Materials and methodsA population-based study was conducted between 2004 and 2010. Claims data of oral squamous cell carcinoma patients were retrieved from the Taiwan Cancer Registry Database. Secondary data were obtained from Taiwan’s National Health Insurance Research Database.ResultsA total of 21,263 patients were included in the final analysis. The majority of the patients received treatment within 30 days of diagnosis (n = 18,193, 85.5%), while 572 patients (2.7%) underwent treatment after 120 days. The patients who were treated after 120 days had a higher risk of death when compared to those treated within 30 days (Hazard ratio: 1.32, 95% Confidence intervals: 1.19 to 1.47).ConclusionA longer time interval from diagnosis to treatment was found to be associated with a poorer prognosis among patients suffering from oral squamous cell carcinoma.

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Initial Experience of a Patient Navigation Model for Head and Neck Cancer

Abstract: The goal of treatment recommendations for HNC within 2 weeks was shown to be reasonable and attainable. Further research should address the delays encountered by patients with psychosocial barriers and those with synchronous lung nodules.

Cited by 12 publications

References 19 publications

Survival impact of treatment delays in surgically managed oropharyngeal cancer and the role of human papillomavirus status

Survival impact of treatment delays in surgically managed oropharyngeal cancer and the role of human papillomavirus status

Association of Treatment Delays With Survival for Patients With Head and Neck Cancer

Influence of time interval from diagnosis to treatment on survival for oral cavity cancer: A nationwide cohort study

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