Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2024

A qualitative exploration of the pathway to diagnosis and treatment of cutaneous squamous cell carcinoma of the head and neck with perineural spread (#397)

Poorva Pradhan 1 , Ke (Zoe) Wan 2 , Li Chan 3 , Tsu-Hui (Hubert) Low 1 4 5 , Raymond Wu 5 6 , Jenny Lee 7 8 , Carsten Palme 1 5 , Jonathan Clark 1 5 9 , Rebecca Venchiarutti 1 2
  1. Department of Head and Neck Surgery, Chris O’Brien Lifehouse, Sydney, NSW, Australia
  2. Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
  3. Department of Radiation Oncology, St George Hospital, Kogarah, Sydney, New South Wales, Australia
  4. Department of Otolaryngology – Head & Neck Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
  5. Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
  6. Department of Radiation Oncology, Chris O’Brien Lifehouse, Sydney, NSW, Australia
  7. Department of Medical Oncology, Chris O’Brien Lifehouse, Sydney, New South Wales, Australia
  8. Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
  9. Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, NSW, Australia

Aims:

Perineural spread (PNS) in cutaneous squamous cell carcinoma of the head and neck (cSCCHN) refers to the spread of malignancy away from the primary tumour along the nerve. PNS is typically associated with a poor prognosis, and early detection is essential to improve outcomes. While evidence has been established of long intervals between symptom onset and diagnosis of PNS, the underlying reasons contributing to delayed diagnosis are not well known. This study aimed to explore events along the pathway to treatment for people with cSCCHN with PNS to identify potential barriers and facilitators of timely diagnosis.

 

Methods:

Patients were identified from an institutional database and invited to participate in semi-structured interviews. Eligible participants were aged ≥18 years, treated between January 2010 and August 2021, with a diagnosis of cSCCHN and clinical and/or radiologic evidence of PNS. Interviews, guided by the Model of Pathways to Treatment, were analysed using a data-driven thematic approach until saturation of themes was reached.

 

Results:

Seventeen participants (76% males, mean age 70 years) took part in the study, with an average time to PNS recurrence of 2.6 years. Facilitators included patients' prior experiences with skin cancer, symptom appraisal and progression, trust in healthcare professionals, and capacity to leverage relationships. Barriers included inconclusive imaging findings that complicated the diagnosis of PNS, lack of care coordination, and limited awareness of PNS among GPs. Additionally, rural patients faced challenges such as limited access to cancer services and long-distance travel, exacerbated by COVID-19 restrictions.

 

Conclusion:

The findings highlight the complexities in diagnosing and treating PNS, underscoring the need for a multidisciplinary approach. Given the rarity of PNS, implementing clinical practice guidelines to increase awareness among GPs and telehealth could improve early diagnosis and accessibility, especially for rural patients. However, the effectiveness of telehealth in this context needs further evaluation.