Head and Neck Cancer Patients Need Coordinated Survivorship Care Planning

Improving oropharyngeal cancer survival rates necessitates better coordination of survivorship care between oncology teams and primary care providers, according to a speaker at the Oncology Nursing Society (ONS) 42nd Annual Congress, held May 4–7 in Denver.

“We need to improve patient education about survivorship and long-term care,” said Minoka Hicks, RN, BSN, BA, OCN, of the Duke Cancer Institute in Durham, North Carolina.

Most oropharyngeal and laryngeal cancers are diagnosed before they have spread to adjacent organs or metastasized to distant sites. The United States sees about 13,400 people newly diagnosed with laryngeal cancers each year, and more than 48,300 with oropharyngeal cancers.

Tobacco is a risk factor for both types of cancer, but pathogenic strains of human papillomavirus (HPV) explain a growing proportion of oropharyngeal malignancies. Cancer incidence related to HPV has increased by more than 200% since the late 1980s, Hicks said.

HPV-associated oropharyngeal cancers are typically diagnosed among nonsmokers with a history of multiple sexual partners. Many patients do not know their HPV status, Hicks and colleagues found.

Patients with HPV-associated cases frequently have a good prognosis: a 3-year overall survival rate of 82%, compared with 57% among HPV-negative patients. Head and neck cancer is now frequently treated with curative intent even at late stages.

That highlights the importance of survivorship care planning (SCP), which should occur no later than 6 months after treatment is completed, Hicks said.

The research team sought to identify patients’ SCP education needs, administering needs-assessment questionnaires during medical oncology, radiation oncology, and otolaryngology clinic appointments. The four-page, anonymous questionnaires asked about 41 participating patients’ lifestyle behaviors, knowledge of long-term treatment effects, and healthcare follow-up planning.

Ninety-six percent of patients reported that they are not current smokers; 59% reported having smoked in the past. Only 10% reported being diagnosed with HPV; 76% said they had not been diagnosed with HPV, and 12% were unsure.

The surveys revealed that among the 86% of patients who had primary care providers, nearly 20% did not believe their primary providers were aware that they had been diagnosed with head and neck cancer. Yet 86% of survey responses indicated that patients believed their oncology team and primary care providers “work together to provide the best care,” and 63% reported that they know how frequently they will need cancer check-ups after completing treatment; 61% reported that they know what testing they will undergo at those cancer check-ups.

The research team plans to explore developing a specialized head and neck cancer SCP to replace the currently-available generic American Society of Clinical Oncology cancer SCP template.