Patient Navigation in Head and Neck Cancer Could Reduce Treatment Delay

A new study found that by introducing a patient-centric navigation system, researchers were able to provide treatment recommendations to the majority of patients with head and neck cancer within a 2-week period.

The patient-navigation system, initiated in 2011, include a nurse coordinator and a patient navigator who worked with patients to coordinate imaging studies, referrals, and surgery with the ultimate goal of evaluating patients, and providing a diagnosis and treatment strategy in a timely manner.

“Variations of timeliness of treatment were still seen in this patient population, but most patients received treatment recommendations within 3 weeks of presentation,” Jason F. Ohlstein, MS, of Tulane University School of Medicine, and colleagues wrote in JAMA Otolaryngology Head and Neck Surgery.

The researchers looked at 100 consecutive patients presenting with squamous cell head and neck carcinoma at Tulane between 2011 and 2014 and assessed the efficiency of the patient navigation model. Three patients were lost to follow-up leaving 97 patients in the final analysis.

The model in the study begins with a patient’s referral to the head and neck clinic. Once referred, the coordinator must make an appointment at the clinic within 2 days. If no definitive diagnosis is made, the patient undergoes additional testing including fine-needle aspiration or imaging. With diagnosis pending, cases are discussed at tumor board meetings on Thursday, with a treatment discussion occurring on Friday. According to the study, this entire process should occur within 2 weeks of diagnosis.

In the study, 51% of the examined patients received treatment recommendations within the 2-week period, with an average time interval of 18.8 days. The median time to treatment recommendation was 15 days.

“Despite buy-in from community and clinician stakeholders, we were only able to achieve this goal for a slight majority of our patients,” the researchers wrote. “Even with this shortfall in our desired outcome, our initial experience achieved our goal more frequently than previously reported studies from European centers.”

The researchers found no significant differences in time to recommendations for patient race (blacks, 17.6 days vs whites, 22.5 days), sex (males, 18.3 vs females, 20.4 days), insurance status (insured, 16.3 days vs uninsured, 19.8 days), or stage at presentation (stage I, 14.4 days vs stage II, 11 days vs stage III, 14.7 days vs stage IV, 21.2 days).

Overall, four outlier patients were identified in the study.

“This initial experience with an aspirational goal also provided important insight into system failures, identifying two outlier groups: (1) those with substantial psychosocial concerns and inadequate social support and (2) those with lung nodules,” the researchers wrote. “Further research should address the delays encountered by patients with psychosocial barriers and those with synchronous lung nodules.”