Rural disparities in head and neck cancer from 2017 to 2021: a single institution analysis

Abstract

Introduction: This study aims to look at the trends in our head and neck cancer patient population over the past 5 years with an emphasis on the past 2 years to evaluate how the coronavirus disease 2019 (COVID-19) pandemic has impacted our disparities and availability of care for patients, especially those living in rural areas. An additional aim is to identify existing disparities at our institution in the treatment of head and neck patients and determine solutions to improve patient care. Materials and Methods: A retrospective chart review was performed to identify patients who were consulted and subsequently treated with at least one fraction of radiation therapy at our institution with palliative or curative intent. Patient demographic information was collected including hometown, distance from the cancer centre based on zip-codes and insurance information and type of appointment (in-person or telehealth). Rural–urban continuum codes were used to determine rurality. Results: A total of 490 head and neck cancer patients (n = 490) were treated from 2017 to 2021. When broken down by year, there were no significant trends in patient population regarding travel distance or rurality. Roughly 20–30% of our patients live in rural areas and about 30% have a commute > 50 miles for radiation treatment. A majority of our patients rely on public insurance (68%) with a small percentage of those uninsured (4%). Telehealth visits were rare prior to 2019 and rose to 5 and 2 visits in 2020 and 2021, respectively. Conclusions: Head and neck cancer patients, despite rurality or distance from a cancer centre, may present with alarmingly enough symptoms despite limitations and difficulties with seeking medical attention even during the COVID-19 pandemic in 2020. However, providers must be aware of these potential disparities that exist in the rural population and seek to address these.

A Rapid Review of Uses and Outcomes of Telehealth Care in Rural and Remote Regions in the United States

“…Overall, acceptance of this type of care delivery was noted in adults and children, 16,21,22,29 but not all patients found telehealth a valuable mechanism for care. 21 A number of studies assessed the satisfaction of the patient and caregiver's use of telehealth platforms for care delivery. Broglio and Kirkland, 20 Cheung et al, 14 and Hutchinson et al 27 reported high levels of agreement that telehealth allowed patients to communicate easily with providers, meeting their needs and serving as equivalent to face-to-face office encounters.…”

“…[9][10][11][12] Of the articles reviewed, various study methods were used, such as randomized trials, [13][14][15][16][17][18] survey types, 19,20 and chart or data review. [21][22][23][24] The gray literature offered guidelines and policies for implementing and promoting effective virtual visits, as well as advocating for continuing coverage and payment of the various telehealth platforms 9-12 (Table 2).…”

“…Of the 18 articles reviewed, 6 defined their use of the term rural/remote using either the US Census Bureau Rural and Urban taxonomy 31 or the Economic Research Service of the US Department of Agriculture. 14,16,18,21,26,32 Several studies included urban and rural communities as participants in their research. 13,19 Many of the studies reviewed did not describe or define the terms of rural and remote.…”

“…Because of wider geographic service areas, programs incur increased costs, reduced touch points, and strained resources. 16,21,30 Pediatric palliative care and hospice programs experience insufficient policy initiatives, lack of trained providers, missing pediatric advance directives, and issues with cultural/social beliefs regarding pediatric death and dying. 17,18,28,29 Uses of Telehealth The use of telehealth for palliative care and hospice services was frequently grouped by disease, such as advanced cancer, 25 heart failure, 13 head and neck cancer, 21 and end-stage renal failure.…”

“…16,21,30 Pediatric palliative care and hospice programs experience insufficient policy initiatives, lack of trained providers, missing pediatric advance directives, and issues with cultural/social beliefs regarding pediatric death and dying. 17,18,28,29 Uses of Telehealth The use of telehealth for palliative care and hospice services was frequently grouped by disease, such as advanced cancer, 25 heart failure, 13 head and neck cancer, 21 and end-stage renal failure. 14 These services included direct communication between the provider and the patient/caregiver, medication management, serving as peer-to-peer consultant role for rural palliative care and hospice teams, and providing education for these rural teams needing skills to care for unique populations, such as children.…”