Implementation of a Novel Subspecialty Outpatient Palliative Medicine Head and Neck Cancer Clinic.

Abstract

Head and neck cancer (HNC) patients have high palliative care (PC) needs. We reviewed our initial experience with a novel subspecialty HNC outpatient PC clinic, led by a Hospice and Palliative Medicine fellowship-trained HNC surgeon. We retrospectively reviewed 142 patients referred to a novel subspecialty HNC PC clinic between July 2023 and March 2025. Symptom evaluation included the revised Edmonton Symptom Assessment System (ESAS-r), Patient Health Questionnaire-9 (PHQ-9) for Depression, Generalized Anxiety Disorder-7 (GAD-7), and frailty. Data were analyzed using cross-tabulations, multivariable linear regression, and multivariable survival analysis. Most patients had incurable disease (73.9%), with significant improvement in ESAS-r shortness of breath, ESAS-r tiredness, GAD-7, and PHQ-9 scores at follow-up. Mortality was 40.1%, and 84.2% of deaths occurred at home or in hospice. Aggressive end-of-life care occurred in 57.9% of patients and was associated with continued cancer-directed treatment (79.4% vs. 26.1%), lower hospice use (55.9% vs. 82.6%), and death in an acute-care facility (27.3% vs. 0%). Palliative immunotherapy was associated with reduced hospice duration (median = 15 days [IQR = 4-63]) compared to other cancer-directed treatment (median = 27 days [23-63]) or supportive care (median = 68 days [26-162]). On multivariable analysis, surgery (HR = 0.08 [95% CI = 0.01-0.39]) and ≥ 3 PC visits (HR = 0.24 [0.08-0.73]) were independent prognostic indicators of survival. Patients seen in a surgeon-led subspecialty HNC PC clinic demonstrated observed longitudinal improvement in symptom scores, improved survival in patients receiving longitudinal PC, and a high rate of home or hospice deaths. These data suggest that subspecialist HNC PC adds value to multidisciplinary HNC care.