Open AccessAn equity‐based narrative review of barriers to timely postoperative radiation therapy for patients with head and neck squamous cell carcinoma
Author(s) -
Noyes Elizabeth A.,
Burks Ciersten A.,
Larson Andrew R.,
Deschler Daniel G.
Publication year - 2021
Publication title -
laryngoscope investigative otolaryngology
Language(s) - English
Resource type - Journals
ISSN - 2378-8038
DOI - 10.1002/lio2.692
Subject(s) - medicine , psychological intervention , socioeconomic status , medicaid , port (circuit theory) , health care , head and neck squamous cell carcinoma , equity (law) , health equity , referral , intensive care medicine , social determinants of health , head and neck cancer , radiation therapy , family medicine , public health , surgery , nursing , environmental health , population , economic growth , economics , political science , law , engineering , electrical engineering
Abstract Objectives The majority of patients with head and neck squamous cell carcinoma (HNSCC) do not commence postoperative radiation treatment (PORT) within the recommended 6 weeks. We explore how delayed PORT affects survival outcomes, what factors are associated with delayed PORT initiation, and what interventions exist to reduce delays in PORT initiation. Methods We conducted a PubMed search to identify articles discussing timely PORT for HNSCC. We performed a narrative review to assess survival outcomes of delayed PORT as well as social determinants of health (SDOH) and clinical factors associated with delayed PORT, using the PROGRESS‐Plus health equity framework to guide our analysis. We reviewed interventions designed to reduce delays in PORT. Results Delayed PORT is associated with reduced overall survival. Delays in PORT disproportionately burden patients of racial/ethnic minority backgrounds, Medicaid or no insurance, low socioeconomic status, limited access to care, more comorbidities, presentation at advanced stages, and those who experience postoperative complications. Delays in PORT initiation tend to occur during transitions in head and neck cancer care. Delays in PORT may be reduced by interventions that identify patients who are most likely to experience delayed PORT, support patients according to their specific needs and barriers to care, and streamline care and referral processes. Conclusions Both SDOH and clinical factors are associated with delays in timely PORT. Structural change is needed to reduce health disparities and promote equitable access to care for all. When planning care, providers must consider not only biological factors but also SDOH to maximize care outcomes.