Background: Head and neck cancers (HNCs) include a heterogeneous group of cancers.1 Due to the diversity and complexity of HNC and the respective treatments, patient care requires highly coordinated collaboration from a multidisciplinary team of specialists and specialized support services for optimal outcomes.2,3
Evidence suggests that communication gaps can occur between patients and providers, as well as among specialists.4 These gaps may impede interdisciplinary collaboration and coordination that are crucial to HNC patient care. The HonorHealth Virginia G. Piper Cancer Care Network (VGPCCN) oncology nurse navigation (ONN) team identified gaps in care in the HNC population after collecting baseline data, including consultation rates; referral rates to nutrition, social work, and speech therapy; and timeliness to care.
Objectives: To bridge gaps across the care continuum by prioritizing referrals to support services and timely education related to diagnosis, treatment, side effects, and nutritional support to enhance the quality of patient-centered HNC care.3
Methods: Due to the complex nature of patients with HNC, the ONN team and the registered dietitian developed a Head and Neck Cancer Education Guide. Along with the guide, our team implemented a bimonthly HNC huddle, which was designed to provide the required resources to our HNC patients in real time to improve timeliness to care. The ONN team also standardized the educational material provided to ensure the information given to patients was the same from each ONN.
Results: Baseline data were collected between November 2019 and February 2020 for a subset of HNC patients. The ONN interventions began in March 2020 and were completed in May 2020. The postintervention data were collected from June 2020 through October 2020 for a similar-sized subset of HNC patients.
Sixty percent of patients met with an ONN at baseline to review diagnosis, treatment, possible side effects, and nutritional support. Postintervention, the rate increased to 100%.
Timely nutritional support is imperative to this population. Timeliness to care was calculated from the date of initial medical oncology consultation to ONN or nutrition consultation. The average number of days at baseline was 24; the average number of days postintervention decreased to 9.
The involvement of specialized support services, including nutrition, social work, and speech therapy, is best practice for HNC patients. At baseline, the referral rate to nutrition was 40%; to social work, 20%; to speech therapy, 40%. Postintervention rates were 100%, 40%, and 80%, respectively.
The rate of ONN or nutrition consults increased by 40%, and referral rates to nutrition, social work, and speech therapy all increased. Time to care from initial medical oncology consult to ONN or nutrition consult decreased by 62.5%.
Conclusions: The HonorHealth VGPCCN ONN team prioritized closing gaps in the care of HNC patients. These efforts aligned evidence-based recommendations with internal processes, which improved patient care and quality of life for the HNC population.
- Saloura V, Langerman A, Rudra S, et al. Multidisciplinary care of the patient with head and neck cancer. Surg Oncol Clin N Am. 2013;22:179-215.
- Jabbour J, Milross C, Sundaresan P, et al. Education and support needs in patients with head and neck cancer: a multi-institutional survey. Cancer. 2017; 123:1949-1957.
- National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines). Head and Neck Cancers. Version 3.2021. www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf.
- Wiederholt PA, Connor NP, Hartig GK, Harari PM. Bridging gaps in multidisciplinary head and neck cancer care: nursing coordination and case management. Int J Radiat Oncol Biol Phys. 2007;69(2 Suppl):S88-S91.