Improvement in Time-to-Treatment Initiation and Use of Ancillary Services for Patients Seen in a Head and Neck Multidisciplinary Clinic at a Safety Net Hospital

A Head and Neck (HandN) Multidisciplinary Clinic (MDC) was implemented in 2017 at a safety net hospital to improve the coordination of care for HandN cancer patients. Patients evaluated in MDC were seen by an ENT surgeon, radiation oncologist, medical oncologist, and speech pathologist at the initial visit compared to non-MDC patients who visited these services separately. In this study, we hypothesized that patients treated in MDC have improvement not only in the utilization of ancillary services and follow-up but also in time-to-treatment initiation (TTI), an important metric in HandN cancer care. We retrospectively reviewed the demographics, ancillary service consultations, treatment information, and follow-up for 85 consecutively treated patients prior to MDC (non-MDC) from 9/2013 to 2/2016 and 42 consecutively treated MDC patients from 10/2017 to 8/2019 with primary HandN cancers treated with radiotherapy (RT). TTI was defined as the time between the date of diagnosis and the initiation of primary treatment, whether RT or surgery. Kaplan-Meier analyses, univariable Cox proportional hazards regression models, and univariable logistic regression models were conducted to estimate hazard ratios (HRs) and odds ratios (ORs) along with corresponding confidence intervals and p-values for the data reviewed. On Kaplan-Meier analysis and Cox proportional hazards regression model of patients receiving primary RT, MDC patients (n = 32) had a significantly decreased TTI compared to non-MDC patients (n = 51) with median TTI for MDC patients being 1.28 months versus 1.91 months for non-MDC patients (HR 0.53 [95% CI: 0.34-0.84; p = 0.006]). We found no significant difference in TTI for patients receiving primary surgery with median TTI for MDC patients (n = 10) being 1.2 months versus 1.31 months for non-MDC patients (n = 34) (HR 1.37 [95% CI: 0.65-2.88; p = 0.411]). Fewer non-MDC patients had nutrition consultations compared to MDC patients (OR 0.44 [95% CI: 0.19 - 0.99; p = 0.046). There was no difference in follow-up between MDC and non-MDC patients; however, there was a shorter time between last RT treatment and follow-up in the MDC group 1.43 months versus non-MDC group 1.45 months (HR 0.65 [95%CI: 0.43-1.0; p = 0.048]). MDC patients who had primary RT showed statistically significant improvement in TTI. This improvement was not seen in MDC patients who had primary surgery and adjuvant RT; however, the cohort of surgical patients was small. The utilization of ancillary services such as nutrition was significantly increased amongst MDC patients. Speech pathology also appeared more accessible for MDC patients; however, a formal assessment could not be performed due to incomplete documentation. Improved TTI, increased ancillary service use, and shorter follow-up time in MDC patients may translate into better treatment outcomes. Future analyses on local recurrence, survival, and quality of life in MDC versus non-MDC patients is needed.