Impact of Presurgical Second-Touch Visits on Delays in Initiating Adjuvant Radiation Therapy.

Abstract

Patients with head and neck squamous cell carcinoma (HNSCC) often encounter delays in starting postoperative radiotherapy (PORT), leading to worse outcomes. We investigated whether attending second-touch visits-appointments after the initial clinic visit and before surgery to address treatment-related questions and follow-up expectations-with an advanced practice provider (APP) is associated with reduced PORT delays. Retrospective cohort study. Single tertiary referral center. Adult patients with HNSCC who underwent free flap surgery and PORT between 2020 and 2022 were included. All patients were offered a second-touch visit. The primary outcome was PORT delay, defined as treatment initiation >42 days after surgery. Clinicodemographic and treatment-related data were collected at baseline and at the last known follow-up. Of the 104 patients included, 57.7% attended a second-touch visit. Attendance was associated with receiving radiotherapy (RT) in an academic setting (65.0% vs 40.9%, P = .015) and fewer PORT delays (56.7% vs 79.5%, P = .015). Multivariable analysis revealed a 70% reduction in odds of PORT delay for those attending second-touch visits (adjusted odds ratio [aOR] = 0.298, 95% CI 0.103-0.866, P = .026). PORT delay was more likely in patients with RT in a community setting (aOR = 3.783, 95% CI 1.284-11.146, P = .016), wound complications (aOR = 5.149, 95% CI 1.363-19.460, P = .016), and a higher comorbidity index (aOR = 1.407, 95% CI 1.012-1.957, P = .042). Attendance of a second-touch visit and RT at a tertiary medical center significantly reduced the likelihood of PORT delay. These findings underscore the importance of APP-driven patient navigation in improving timely care and outcomes for patients with HNSCC.