Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2024

Delays to Post-Operative Radiation Therapy for Patients with Head and Neck Squamous Cell Carcinoma: A Mixed-Methods Analysis of Health Worker Perspectives (#316)

Ravi Marwah 1 2 , Justin Smith 2 3 , Daniel Goonetilleke 4 , Madhavi Chilkuri 2
  1. Department of Radiation Oncology, Townsville University Hospital, Townsville, Queensland, Australia
  2. College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
  3. Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
  4. Dalby Hospital, Dalby, Queensland, Australia

Background:

Post-operative radiation therapy (PORT) delays are associated with reduced survival and higher recurrence rates in patients with head and neck squamous cell carcinoma (HNSCC).1-3 Our previous work evaluating PORT delays at Townsville University Hospital (TUH) reported greater delays in Indigenous patients and patients receiving surgery at external facilities.4 The objective of this study was to explore health worker perspectives on barriers and solutions to timely PORT.

Methods:

This paper incorporated an explanatory sequential mixed methods design. Healthcare workers involved in the care of patients with HNSCC at TUH were invited to participate. Participants completed an online survey and subsequently underwent semi-structured focus group interviews. Key themes were explored using thematic analysis, with recruitment for interviews terminated at thematic saturation.

Results:

Nineteen healthcare workers participated in the surveys. The three factors most attributed to PORT delays were regional/rural location (89%), surgery at an external facility (84%), and Indigenous status (74%). Ten healthcare workers subsequently participated in interviews. Three themes regarding solutions to PORT delays were identified; overcoming cultural barriers, addressing care fragmentation, and improving care coordination. Strategies proposed to overcome cultural barriers included instituting cultural immersion programs, promoting earlier Indigenous Liaison Officer engagement, supporting family involvement, and developing culturally appropriate resources for patients and families. Solutions suggested to address care fragmentation included streamlining referral systems, utilising electronic reminders, avoiding double-handling of care, and increasing local service provision. Strategies proposed to improve care coordination included flagging patients early, timely organisation of transport & accommodation, and employing head and neck-specific cancer care coordinators.

Conclusion:

This study highlights barriers and solutions to timely PORT in an Australian regional centre with a large Indigenous population. Strategies aimed at both the patient and systems level and formed in partnership with Indigenous peoples must be instituted to address delays and reduce systemic health disparities.

  1. Harris JP, Chen MM, Orosco RK, Sirjani D, Divi V, Hara W. Association of survival with shorter time to radiation therapy after surgery for US patients with head and neck cancer. JAMA Otolaryngol Head Neck Surg 2018; 144: 349–59.
  2. Ang KK, Trotti A, Brown BW et al. Randomized trial addressing risk features and time factors of surgery plus radiotherapy in advanced head‐and‐neck cancer. Int J Radiat Oncol Biol Phys 2001; 51: 571–8.
  3. Franco R, Marta GN. Timing factors as prognostic variables in patients with head and neck squamous cell carcinoma treated with adjuvant radiotherapy: a literature review. Rev Assoc Med Bras 2020; 66: 380–4.
  4. Marwah R, Goonetilleke D, Smith J, Chilkuri M. Evaluating delays in patients treated with post-operative radiation therapy for head and neck squamous cell carcinoma. J Med Imaging Radiat Oncol. 2022 Sep;66(6):840-846.