Opportunities to advance head and neck cancer survivorship care: Perspectives from community oncology providers (HN-STAR WF-1805CD).

Abstract

367 Background: Head and neck cancer (HNC) survivors experience complex and long-term physical and psychological issues following treatment completion. Clinical guidelines recommend routine monitoring of symptoms and behaviors, surveillance for new cancers and recurrences, and coordinated management of treatment-related effects. However, implementation in community oncology settings remains challenging, and little is known about HNC survivorship care delivery in routine oncology practice, including factors that influence guideline-concordant symptom management. Methods: We conducted a mixed-methods study using baseline survey data and qualitative interviews from the Wake Forest NCI Community Oncology Research Program Research Base HN-STAR trial (NCT04208490). Clinicians from 28 oncology practices completed surveys on survivorship practices (symptoms, distress, tobacco use, nutrition, physical activity). A subset participated in semi-structured interviews exploring survivorship assessment, referrals, care coordination, and management of treatment-related effects. Quantitative data were analyzed descriptively; qualitative data were analyzed deductively using the Survivorship Care Quality Framework domains of cancer survivorship care and delivery. Results: Eighty clinicians (69% MD/DO, 31% NP/PA) from multiple specialties (59% medical oncology, 30% radiation oncology) completed the survey (2020-2023). Respondents cared for patients across practice settings (e.g., 55% medical, 29% radiation oncology, 9% HN surgery) and regions (58% Midwest, 22% South, 19% Northeast). Most clinicians reported assessing symptoms (94%), tobacco use (90%), nutrition (89%), distress (69%), and physical activity (59%) during post-treatment follow-up visits. Assessments were conducted primarily before/during clinic visits, with limited use of standardized tools (<20% for most symptoms, 62% for distress). Qualitative interviews (n=36) identified multiple barriers to survivorship care, including challenges monitoring patient needs between visits, limited systematic processes for symptom assessment, managing late-appearing symptoms (e.g., dysphagia, pain), and constrained access to supportive services, particularly dental care. Other barriers included difficulties coordinating care across disciplines and health systems (e.g., patients traveling long distances for care, limited specialty access). Conclusions: Findings reveal a persistent gap between guideline recommendations and survivorship care delivery in community oncology practices, driven by structural and workflow barriers that limit systematic assessment, care coordination, and follow-up for HNC survivors. The data underscore the complexity of HNC survivorship and the need for enhanced coordination and systematic symptom monitoring to improve quality of care. Clinical trial information: NCT04208490 .