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Background Head and neck cancers often require multidisciplinary treatment. Because of the functional implications of both the underlying disease, as well as proposed treatments, pretreatment workup can involve speech pathology, dentistry, nutrition, radiology (including interventional), social work, pain management teams, and more. These many appointments and interventions can delay initiation of treatment especially for patients who need more complex care. During this time, tumors progress and patients experience prolonged symptoms.

Objective To assess the effect of concurrent implementation of a pretreatment care map and a nurse navigator on the time-to-treatment interval.

Methods A prospective, single-center review of all patients presenting to a multidisciplinary head and neck service line within an academic cancer center was conducted. Electronic medical record analytics incorporated into the pretreatment care map were used to determine time from presentation/diagnosis to initiation of treatment. The percentage of patients initiating treatment within 30 days of diagnosis/presentation was also recorded.

Results The time from referral/diagnosis to treatment from quarter 1 through quarter 4 was 57.2, 42.3, 29.6, and 29.7 days, respectively. The standard deviation of time to treatment from quarter 1 through quarter 4 was 27.8, 26.8, 20.4, and 17.4 days, respectively. The percentage of patients treated within 30 days from quarter 1 through quarter 4 was 18%, 22%, 60%, and 45%, respectively.

Conclusions A standardized head and neck cancer pre-treatment care map facilitated by a cross-disciplinary nurse navigator reduces the time to treatment for head and neck cancer patients requiring complex multidisciplinary care.

References

Fillion L, de Serres M, Cook S, Goupil RL, Bairati I, Doll R. Professional patient navigation in head and neck cancer. Semin Oncol Nurs. 2009;25(3):212-221.

Chapman A. Nurse navigator: the missing piece of the head and neck cancer care continuum. ORL Head Neck Nurs. 2011;29(2):6-7.

Ohlstein JF, Brody-Camp S, Friedman S, Levy JM, Buell JF, Friedlander P. Initial experience of a patient navigation model for head and neck cancer. JAMA Otolaryngol Head Neck Surg. 2015;141(9):804-809.