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Patient navigation model appears feasible in head, neck cancer
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A patient navigation model aimed at offering treatment recommendations to patients with head and neck cancer within 2 weeks of presentation appeared reasonable and attainable, according to the results of a retrospective analysis.
Specific temporal goals for the treatment of head and neck cancer are regularly used in Europe but not in the U.S., according to the researchers.
“Effective management of cancer and, in particular, head and neck cancer poses a substantial challenge to the health care system,” Paul Friedlander, MD, chair of otolaryngology and clinical associate professor of surgery at Tulane University, and colleagues wrote. “The majority of patients with head and neck cancer present with advanced disease, in conjunction with substantial medical comorbidities, and frequently concurrent low socioeconomic status. … Patient navigation has been previously identified and extensively proposed as a principal strategy to improve the outcomes for these at-risk populations for cancer and other medical conditions.”
Friedlander and colleagues sought to assess the temporal impact of using an aspirational goal in a patient-centered navigation system at the time from presentation to the formulation of a treatment plan for patients with head and neck cancer.
Researchers retrospectively reviewed 100 consecutive patients treated for squamous cell carcinoma of the head and neck between 2011 and 2014 to determine the efficiency of a patient-centered navigational model for delivering treatment recommendations. Nurses were assigned to each patient to act has a patient navigator. The navigator established clinic care within 2 days and reviewed previous diagnostic test results. The patient underwent additional tests, biopsies and panendoscopies as necessary, and their case was discussed at a multidisciplinary tumor board meeting.
The ability to provide treatment recommendations within a 2-week period following diagnosis served as the model’s aspirational goal.
The study included data from 93 patients (mean age, 63.4 years; 80% men). Most patients were white (87%; n = 81) and 69% (n = 64) were insured by Medicare or Medicaid.
Fifty-one percent of patients (n = 49) received treatment recommendations within 2 weeks of initial presentation (median, 15 days; mode, 14 days). The mean interval was 18.8 days (standard deviation, 18.6).
Outliers to the model included two patients with synchronous lung nodules, who received their treatment recommendations after 72 days and 85 days; and two patients with psychosocial barriers, who received their recommendations after 107 days and 86 days.
No significant differences to the mean time to treatment interval occurred with respect to patient race (black, 17.6 vs. white, 22.5), sex (men, 18.3 vs. women, 20.4), insurance status (insured, 16.3 vs. uninsured, 19.8) and stage at presentation (stage I, 14.4; stage II, 11; stage III, 14.7; stage IV, 21.2).
The researchers acknowledged limitations of their study, including the lack of a control group and the use of data collected from a single treatment center. Further, they acknowledged the overall homogeneity of the study population.
“With the introduction of a patient-centric navigation system driven by an aspirational goal, the clinic was able to render treatment recommendations for the majority of patients with head and neck cancer within 2 weeks of presentation,” Friedlander and colleagues wrote. “Furthermore, we identified two subgroups who experienced substantial delay: those lacking in psychosocial support and those with synchronous lung nodules. Further investigation will be necessary to determine external validity and applicability to high-risk populations.” – by Cameron Kelsall
Disclosure: The researchers report no relevant financial disclosures.
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