Colocated Multidisciplinary Clinic Is Associated With Improved Timeliness to Postoperative Adjuvant Therapy in Head and Neck Cancer Patients.

Abstract

Delays in postoperative adjuvant therapy, particularly PORT, have been shown to decrease survival, decrease oncologic locoregional control (LRC), and increase the risk of recurrence. Timely initiation of PORT, within 42 days of primary surgical resection, is recommended by the American College of Surgeons Commission on Cancer (CoC), but 55%-70% of patients do not meet this goal. We aimed to investigate whether our recent transition to a multidisciplinary care (MDC) model would have a significant impact on meeting this metric compared to our prior sequential care model, wherein patients see each cancer care provider at a separate visit. Data were collected and retrospectively reviewed. Two cohorts were identified: pre-MDC initiation (November 2018-April 2019) and post-MDC initiation (September 2022-February May 2024). Our outcomes of interest included median time to adjuvant therapy, percent of patients who achieved timely adjuvant therapy initiation, defined as initiation within 6 weeks of primary surgical resection as recommended by the CoC guidelines, percentage of patients evaluated by a dentist in MDC, and percentage of patients who completed intraoperative dental extractions. One hundred fifty-seven patients met inclusion criteria and baseline characteristics were statistically similar between the two cohorts. Postoperative delays were common in the pre-MDC cohort (69.6%, 32/46) compared with the post-MDC cohort (47.7%, 53/111) associated with 2.5-fold higher odds of delay (OR 2.50, 95% CI [1.20-5.18]; p = 0.013). Accordingly, the median time to PORT/POCRT was longer in the pre-MDC cohort (49 days) compared to the post-MDC cohort (43 days; p = 0.003). The post-MDC era was associated with a significantly faster time to adjuvant therapy initiation (HR 2.44, 95% CI [1.52-3.92]; p < 0.001). Thus, a greater proportion of patients in the post-MDC cohort (49.5%, 55/111) met the CoC guideline criteria compared with the pre-MDC cohort (28.3%, 13/46; OR 4.13, 95% CI [1.45-11.78]; p = 0.008). We also analyzed patients in two sub-cohorts in our post-MDC period; post-MDCND (no reliable dental evaluation in MDC) and post-MDCD (with reliable addition of a dentist in MDC). In the post-MDCD group, patients were more likely to be evaluated by a dentist (78.6% (44/56) vs. 38.2% (21/55), p < 0.001) and more likely to complete recommended intraoperative dental extractions at the time of primary surgical resection (100% (7/7) vs. 50.0% (6/12), p < 0.05) when compared with the post-MDCND cohort. Patients seen in the post-MDC era were associated with an almost two and a half times more likely chance to start PORT/POCRT on time and were observed to have a fourfold better adherence to the CoC guidelines for timely adjuvant therapy initiation than those in the pre-MDC era. A colocated MDC may have enabled improved care coordination by helping to streamline communication, prophylactically identifying and mitigating potential delays in care, and developing comprehensive treatment plans that may have helped to improve timely adjuvant care.