Researchers identify key themes driving multilevel barriers to the delivery of timely, guideline-adherent adjuvant therapy for patients with head and neck cancer (JCO Oncol Pract. 2020;OP2000271. doi:10.1200/OP.20.00271).
“Delays initiating guideline-adherent postoperative radiation therapy (PORT) in head and neck squamous cell carcinoma (HNSCC) are common, contribute to excess mortality, and are a modifiable target for improving survival,” explained Evan M Graboyes, MD, MPH, Medical University of South Carolina, Charleston, South Carolina, and colleagues.
“However, the barriers that prevent the delivery of timely, guideline-adherent PORT remain unknown,” they continued.
Researchers conducted interviews with key informants with a purposive sample of patients with HNSCC and oncology providers across diverse practice settings until thematic saturation (n = 45).
Thematic analysis was performed to identify the themes that explain barriers to timely PORT and to develop a conceptual model.
Overall, the analysis included 27 patients undergoing surgery and PORT for HNSCC. Additionally, 18 clinicians from 7 oncology practices participated in key informant interviews.
Dr Graboyes and colleagues identified 5 key themes representing barriers to timely PORT.
- inadequate education about timely PORT;
- postsurgical complications that interrupt the tight treatment timeline;
- insufficient coordination and communication during care transitions;
- fragmentation of care across health care organizations;
- and travel burden for socioeconomically disadvantaged patients.
“This study provides a novel description of the multilevel barriers that contribute to delayed PORT. Interventions targeting these multilevel barriers could improve the delivery of timely, guideline-adherent PORT and decrease mortality for patients with HNSCC,” Dr Graboyes and colleagues concluded.—Janelle Bradley
