In a recently published study in the Journal of Clinical Oncology - Oncology Practice, investigators from MUSC Hollings Cancer Center classify numerous barriers to a recommended therapy for head and neck cancer that may mean the difference between life and death for these patients.
Cancer of the head and neck is one of the deadliest cancers. Only half of those with head and neck cancer are alive five years following initial diagnosis. African Americans, in particular, experience worse survival outcomes. These patients are 50% more likely to die from the disease than white people, a concerning trend that has prompted deeper research into factors that might drive these significant disparities in head and neck cancer mortality.
The Hollings study team is led by Evan Graboyes, M.D., a surgeon scientist who is examining how to improve the timeliness and equity of care delivery to decrease head and neck cancer recurrence and improve survival. "The key measure of timely head and neck cancer care is the time between when patients get surgery and when they start their radiation. When people get their care within six weeks, it is less likely to recur. Unfortunately, we also know that nationally about half of head and neck cancer patients don't get their radiation started on time, and that radiation treatment delays disproportionately burden African Americans."
To understand more fully factors contributing to head and neck cancer treatment delays, Graboyes and his team conducted structured interviews with patients, providers, nurses, nurse practitioners, surgeons and radiation and medical oncologists across South Carolina. "It's a qualitative study," Graboyes explained, "where the key unit of analysis isn't numbers but rather words and stories. Qualitative studies are really helpful for providing an in-depth understanding of experiences that patients, providers and other interviewees can offer us."
Multiple levels of barriers
What makes this issue complex is that there are multiple obstacles that interact to prevent a patient from getting radiation treatment in a timely manner. The researchers found those obstacles include:
A lack of patient and provider education on national standards of care.
Unexpected post-surgical complications that interrupted tight treatment timelines.
Poor communication between medical teams.
Burdensome travel requirements to see different specialists.
"One of the interesting things we found is that patients might experience several of these barriers, just at different points in time during their treatments," Graboyes said. "Their difficulties were constantly evolving as they progressed through the cancer care continuum."
