What is the hold up?—Mixed-methods analysis of postoperative radiotherapy delay in head and neck cancer

Abstract

Background: Delays in postoperative radiotherapy (PORT) for head and neck cancer (HNC) increase the risk for recurrence and mortality. The multifactorial nature of delays calls for an in-depth understanding of potential contributors from the patient's and provider's perspectives. We sought to identify causes of delays in adjuvant radiotherapy initiation for HNC. Methods: We performed a mixed-methods study including patients with HNC care team members. Forty in-depth interviews were performed (26 patients; 14 care team members). Timing and demographic data were collected from medical records. Results: Median time from surgery to radiotherapy initiation was 45 days; 15 participants began after 42 days. Process delays and failure to communicate the urgency and significance of PORT initiation contributes to delays. Patients with a strong social support system experience less delays. Conclusions: Achieving reductions in PORT initiation requires efficient care coordination, improved communication between interdisciplinary teams, and strengthening social support systems for patients with HNC.