Beginning survivorship care for head and neck cancer patients earlier is linked to better survival and lower recurrence, according to a new University of Pittsburgh study published today in JAMA Otolaryngology–Head & Neck Surgery .
The study found that patients who participated in a multidisciplinary survivorship clinic before or early in radiotherapy had better outcomes than patients who participated after treatment. The study is among the first to show that timing of survivorship care is associated with patient outcomes, and unlike many factors in cancer care, it can be modified relatively easily.
"I think a lot of times survivorship care is seen as just something that is nice to have but is not essential," said senior author Marci Lee Nilsen, Ph.D., R.N., professor of otolaryngology at Pitt's School of Medicine and director of the UPMC Head & Neck Cancer Survivorship Clinic . "This study shows that if we just shift survivorship care a bit earlier, patients have better outcomes, better adherence to treatment. And even when you control for treatment adherence, you see an association between earlier care and survival."
Survivorship care provides long-term, multidisciplinary support for cancer patients and survivors, focusing on mental and physical health, managing symptoms and monitoring for cancer recurrence. Ideally, the care begins at diagnosis and extends through the end of the patient's life. In practice, it is more commonly emphasized after treatment ends.
"Survivorship care does vary across cancers, but generally, the standard is that all cancer survivors have access to survivorship resources after treatment," Nilsen said. "This study challenges that paradigm. I questioned why we intervene after symptoms and side effects have developed, when we could intervene earlier and hopefully prevent or mitigate them."
At the UPMC Hillman survivorship clinic , patients see a multidisciplinary team, including specialists in speech-language pathology, physical therapy, nutrition and dental care, in a single same-day visit ending with a treatment summary and care plan for the patient, their oncology team and their primary care clinician. Nilsen's team previously showed that earlier survivorship care improved patients' quality of life and psychological well-being. But she wanted to know if earlier intervention could improve patients' odds of surviving.
To investigate this, the researchers analyzed data from 471 head and neck cancer patients, 148 of whom received early survivorship care. They found that patients who participated in early survivorship care were about half as likely to miss or stop radiotherapy. Earlier care was also associated with a lower risk of recurrence and death three years after treatment, even after adjusting for treatment adherence. This suggests that the benefits of earlier care are not solely due to completing radiotherapy.
This study is among the first to show an association between timing of survivorship care and cancer survival. The results suggest that a relatively minor shift in care could have a significant impact on patients' health outcomes.
"We have a growing population of cancer survivors who are being cured and living longer. But a cure is not the only endpoint for survivors," Nilsen said. "They want to live the best life they can. Survivors will tell you how beneficial it has been for them having survivorship care support along that journey."
Future studies will investigate how adjusting the timing of survivorship care affects cost and utilization. The researchers also propose a randomized controlled trial to isolate the impact of survivorship care timing from other aspects of cancer care.
Additional authors on the current study are Katie Carlson, M.P.H., Maryanna Owoc, M.D., Ph.D., Rida Ashraf, Jennifer Hetrick, Seungwon Kim, M.D., Jose Zevallos, M.D., M.P.H., Matthew Spector, M.D., Kevin Contrera, M.D., M.P.H., Yvonne Mowery, M.D., Ph.D., Dan Zandberg, M.D., Christopher Wilke, M.D., Ph.D., Jonas Johnson, M.D., and Angela Mazul, Ph.D., M.P.H., all of Pitt, UPMC Hillman Cancer Center, or both, and Motassem Bayyoud of Wright State University .
This research was supported by the National Institutes of Health (P50 CA097190-17, Head and Neck Specialized Program of Research Excellence; P30CA047904) and the Gordon and Betty Moore Foundation through the Betty Irene Moore Fellowship for Nurse Leaders and Innovators (GBMF9048).
